25-368 New Law Expands Protections for Survivors of Rape and Sexual Assault
Date: 04/21/25
Bill select services correctly to ensure members are covered with no cost share — effective July 1, 2025
Effective July 1, 2025, Health Net will cover emergency room care and follow-up medical treatment without any member cost share for members who have suffered rape or sexual assault. These changes are tied to requirements in Assembly Bill (AB) 2843.
Participating physicians and other providers must adhere to the coverage changes outlined below as part of their Health Net Provider Particiption Agreement (PPA).
Coverage details
Members may obtain any of the following services for rape or sexual assault without any member cost share from the start of treatment (members enrolled in a high deductible health plan (HDHP) are subject to Plan deductible):
- Emergency room care.
- Follow-up treatments, including any medical or surgical services for the diagnosis, prevention or treatment of medical conditions arising from an instance of rape or sexual assault.
- Mental health treatments.
- Out-of-network services if medically necessary care is not available within the member’s network.
Medi-Cal only: No prior authorization needed for services from non-participating providers
As a part of the Medi-Cal covered benefit, Medi-Cal members may access care from non-participating providers for sensitive services without prior authorization.
How to bill for services
Please correctly bill services provided to members seeking treatment for rape or sexual assault. Claims must be billed with the appropriate diagnosis code to identify services provided to members seeking treatment for rape or sexual assault. Refer to the table below for the diagnosis codes recognized and covered by Health Net that pertain to rape or sexual assault.
Please note: prescriptions given for member care will need to include the relevant diagnosis code(s).
What is defined as rape and sexual assault?
Under California law, rape and sexual assault generally involve non-consensual sexual acts. Below is a simple breakdown as derived from the California Penal Code (PC). You can access the detailed definitions at California Legislative Information website.
- Rape (PC 261, 263, 263.1): Non-consensual sexual intercourse accomplished through force, threats, fraud, or when the victim is unable to give consent due to intoxication, unconsciousness, or mental incapacity.
- Consent (PC 261.6): A voluntary, freely given agreement to engage in sexual activity. Lack of resistance does not imply consent.
- Sodomy and oral copulation (PC 286, 287): Engaging in anal or oral sex without consent, using force, threats, or exploiting a victim's inability to resist.
- Sexual acts with a child (PC 288.7): Any sexual intercourse, sodomy, or oral copulation with a child under 10 years old is a felony.
AB 2843 explained
For more information regarding AB 2843, visit AB-2843 Health care coverage: rape and sexual assault.
Diagnosis codes for billing rape and sexual assault services
CPT Copyright 2025 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
Diagnosis code | Description |
|---|---|
T7421XA | Adult sexual abuse, confirmed, initial encounter |
T7421XD | Adult sexual abuse, confirmed, subsequent encounter |
T7421XS | Adult sexual abuse, confirmed, sequela |
T7422XA | Child sexual abuse, confirmed, initial encounter |
T7422XD | Child sexual abuse, confirmed, subsequent encounter |
T7422XS | Child sexual abuse, confirmed, sequela |
T7621XA | Adult sexual abuse, suspected, initial encounter |
T7621XD | Adult sexual abuse, suspected, subsequent encounter |
T7621XS | Adult sexual abuse, suspected, sequela |
T7622XA | Child sexual abuse, suspected, initial encounter |
T7622XD | Child sexual abuse, suspected, subsequent encounter |
T7622XS | Child sexual abuse, suspected, sequela |
O9A411 | Sexual abuse complicating pregnancy, first trimester |
O9A412 | Sexual abuse complicating pregnancy, second trimester |
O9A413 | Sexual abuse complicating pregnancy, third trimester |
O9A419 | Sexual abuse complicating pregnancy, unspecified trimester |
O9A42 | Sexual abuse complicating childbirth |
O9A43 | Sexual abuse complicating the puerperium |
Z0441 | Encounter for examination and observation following alleged adult rape |
Z0442 | Encounter for examination and observation following alleged child rape |
T745 | Forced sexual exploitation, confirmed |
T7451 | Adult forced sexual exploitation, confirmed |
T7451XA | Adult forced sexual exploitation, confirmed, initial encounter |
T7451XD | Adult forced sexual exploitation, confirmed, subsequent encounter |
T7451XS | Adult forced sexual exploitation, confirmed, sequela |
T7452 | Child sexual exploitation, confirmed |
T7452XA | Child sexual exploitation, confirmed, initial encounter |
T7452XD | Child sexual exploitation, confirmed, subsequent encounter |
T7452XS | Child sexual exploitation, confirmed, sequela |
Z0481 | Encounter for the examination and observation of victim following forced sexual exploitation |
T7651 | Adult forced sexual exploitation, suspected |
T7651XA | Adult forced sexual exploitation, suspected, initial encounter |
T7651XD | Adult forced sexual exploitation, suspected, subsequent encounter |
T7651XS | Adult forced sexual exploitation, suspected, sequela |
T7652 | Child sexual exploitation, suspected |
T7652XA | Child sexual exploitation, suspected, initial encounter |
T7652XD | Child sexual exploitation, suspected, subsequent encounter |
T7652XS | Child sexual exploitation, suspected, sequela |
Additional information
Relevant sections of Health Net’s provider operations manuals and the Behavioral Health Provider Operations Manual have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.