MedicaidCoverageHigh impact
26-1036 Order Prenatal Screening Through Approved Programs and In-Network Laboratories
Health Net·CA · OB-GYN, Family Medicine, General Practice +1 more·Prior Authorization
We identified it
Aug 29, 2026
Summary
Health Net Medi-Cal has issued a critical policy clarifying where prenatal screening services must be ordered to avoid claim denials. Prenatal aneuploidy screening (CPT 81420) must be ordered through the California Department of Public Health (CDPH) Prenatal Screening Program only—orders submitted to Health Net will be denied. The BillionToOne prenatal carrier screening panel (CPT 0449U) is not covered. Standard prenatal carrier screening requires individual component tests through in-network laboratories only.
Action Required
Immediately implement the following controls in billing systems and provider ordering workflows for all Medi-Cal members in the specified counties (Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne): (1) BILLING TEAM: Block claims for CPT 81420 ordered outside the CDPH Prenatal Screening Program and deny internally before submission to prevent Health Net denials. (2) PROVIDERS & ORDERING STAFF: Remove CPT 0449U (BillionToOne panel) from order sets and templates—this is not a covered Medi-Cal benefit and will result in claim denials. (3) BILLING TEAM: Update billing system rules to require in-network laboratory (Labcorp, Quest Diagnostics) for all standard prenatal carrier screening using individual component CPT codes. (4) ALL STAFF: Provide providers with CDPH Prenatal Screening Program laboratory list and ordering requirements to ensure compliance. (5) FRONT DESK/PRIOR AUTH: Do NOT submit prior authorization requests to Health Net for CPT 81420—these will be automatically denied; instead, ensure orders route through CDPH program. Failure to comply will result in claim denials, payment delays, and rework. Contact Health Net Provider Services at 800-675-6110 for questions.