25-589m Accurate Diagnosis Code Placement for Prescriptions Related to Rape and Sexual Assault

Date: 06/20/25

Ensure accurate and visible diagnosis codes for seamless prescription processing

As a reminder, effective July 1, 2025, Health Net will cover emergency room care, follow-up medical treatment, mental health treatment and out-of-network services if those services are unavailable within the network without any cost share for members who have suffered rape or sexual assault. These changes are tied to the requirements outlined in Assembly Bill (AB) 2843.

Commercial only: High deductible health plans (HDHP) are subject to plan deductible.

Paper or electronic prescriptions must include the diagnosis code

Health Net requires the following placement for ICD-10 diagnosis codes on prescriptions:

• For paper prescriptions, the ICD-10 diagnosis code must be clearly visible on the prescription.
• For electronic prescriptions, consult your electronic medical record system (EMR) to determine the correct placement of the diagnosis code. Contact your EMR vendor for questions on how or where to place the diagnosis code.

Additional information

For additional details about coverage changes as a result of AB 2843 and the diagnosis code table, please refer to provider update 25-368, New Law Expands Protections for Survivors of Rape and Sexual Assault, distributed on    April 21, 2025. You can access this update online in the Provider Library, then select Medi-Cal > Provider Updates and Notices > scroll or search for 25-368.

Relevant sections of Health Net’s provider operations manuals have 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.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) 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.