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Health NetMedicaid · Prior Auth · Prior Authorization · CA · Orthopedics, Neurology, Pain Management +8 moreHigh impact

20-438 Medical Policies - 1st Quarter 2020

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

CalViva Health updated multiple medical policies for Q1 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties. Key changes include new coronavirus testing guidelines, updated DME criteria, revised surgical procedure coverage, and modified prior authorization requirements for various treatments.

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What to do

immediately · 3 steps
01Billing teams must review and update authorization requirements for affected procedures including DME items, facet joint injections, nerve blocks, and transplant services.
02Update billing system to reflect new coverage criteria for male vacuum erection devices (now covered), cold pad pumps (now not covered), and coronavirus testing per CDC guidelines.
03Ensure prior authorization is obtained where newly required and verify coverage criteria changes are reflected in encounter forms and billing software.

Codes mentioned

E1399E0849E0770E230038206D59.5D75.81Z94.8364625644516447964480G56.00G56.93M50.00M50.93M54.12M54.13R06.2K0108K0739

Original notice

20-438 Medical Policies - 1st Quarter 2020
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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Related changes

See all Health Net changes →
20-435 Medical Policies - 1st Quarter 2020HighNo effective date · Prior Authorization20-437 Medial Policies - 1st Quarter 2020HighNo effective date · Prior Authorization20-947 Medical Policies - 3rd Quarter 2020MediumNo effective date · Prior Authorization20-944 Medical Policies - 3rd Quarter 2020MediumNo effective date · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesOrthopedicsNeurologyPain ManagementUrologyOB-GYNOncologyPulmonologyCardiothoracic SurgeryGeneral SurgeryAllergy & ImmunologyFamily MedicineCode E1399Code E0849Code E0770Code E2300Code 38206Code D59.5Code D75.81Code Z94.83Code 64625Code 64451Code 64479Code 64480Code G56.00Code G56.93Code M50.00Code M50.93Code M54.12Code M54.13Code R06.2Code K0108Code K0739

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