Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Health NetMedicaid · Prior Auth · Prior Authorization · CA · Palliative Care, OB-GYN, Orthopedics +6 moreMedium impact

26-1191m Updates to Clinical Policies – September 2026

Effective date
Sep 1, 2026
Identified
Oct 16, 2026

Summary

Community Health Plan of Imperial Valley updated five clinical policies effective September 2026, including changes to prior authorization criteria for hospice services, obstetrical home care, durable medical equipment, orthognathic surgery, and hematopoietic cell therapy. Billing teams must update systems to reflect removed DME codes (L1933, L1952, L8030, L8035), revised clinical thresholds (orthognathic surgery overjet and molar relationship measurements), and new equipment coverage (External Lower Extremity Sensory Prosthetic Device, OLE Therapy Devices). These changes affect prior authorization workflows and claims submission for Medi-Cal members in Imperial County.

Get alerts when payers change rules like this one

We check Health Net and other payers every day and email you when a change matches your specialty and state.

Get Health Net alertsPolicy Monitoring is free. No card required.

What to do

Action · 9 steps
01Effective September 2026, billing and prior authorization teams must.
02Remove HCPCS codes L1933, L1952, L8030, and L8035 from coverage edits and billing systems for Community Health Plan of Imperial Valley Medi-Cal members, as Ankle-Foot Orthotics (AFO) and Lower Extremity Prosthetics sections have been deleted.
03Update prior authorization logic for Wearable Cardioverter-Defibrillator (WCD) coverage under CP.MP.107 to reflect 30-day incremental approval language.
04Revise orthognathic surgery (CP.MP.202) prior authorization criteria to reflect updated measurement thresholds (overjet changed from >5 mm to ≥5 mm; maxillary/mandibular molar relationship discrepancy changed from >4 mm to ≥4 mm).
05Add new DME categories to billing systems: External Lower Extremity Sensory Prosthetic Device (Walkasins®) and Oscillation and Lung Expansion (OLE) Therapy Devices with applicable HCPCS codes.
06Update blood glucose monitor criteria language from 'legally blind' to 'severe visual impairment' in prior authorization templates.
07Providers requesting prior authorization for the listed services must reference updated policy numbers CP.MP.54, CP.MP.91, CP.MP.107, CP.MP.202, and CP.MP.249.
08Failure to update systems may result in claim denials or unnecessary prior authorization requests.
09Refer to Community Health Plan of Imperial Valley provider library for complete policy text (833-236-4141; Behavioral Health: 844-966-0298).

Codes mentioned

L1933L1952L8030L8035

Original notice

26-1191m Updates to Clinical Policies – September 2026
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
View original ↗

Related changes

See all Health Net changes →
26-1190m Updates to Clinical Policies – September 2026HighEffective Sep 1, 2026 · Prior Authorization26-1192m Updates to Clinical Policies – September 2026HighEffective Sep 1, 2026 · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesPalliative CareOB-GYNOrthopedicsOral & Maxillofacial SurgeryOncologyPulmonologyEndocrinologyPM&R (Physical Medicine & Rehab)CardiologyCode L1933Code L1952Code L8030Code L8035

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account