All Insurance Policy Changes (Page 1137)

Continuing from page 1136. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
MA11.023m, Hyaluronan Therapies for Osteoarthritis of the Knee
Independence Blue Cross·Effective Jan 2, 2026
Medicare Advantage policy MA11.023m for Hyaluronan Therapies for Osteoarthritis of the Knee has been updated with an effective date of January 2, 2026. This policy change affects coverage criteria for hyaluronic acid injections used to treat knee osteoarthritis.
Low impact
MA08.023d, Enzyme Replacement for the Treatment of Gaucher's Disease
Independence Blue Cross·Effective Jan 2, 2026
Medicare Advantage policy MA08.023d for Enzyme Replacement Therapy for Gaucher's Disease has been updated. This affects coverage and billing requirements for enzyme replacement treatments used to treat Gaucher's disease patients under Medicare Advantage plans.
Medium impact
MA11.004q, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Independence Blue Cross·Effective Jan 1, 2026
This policy (MA11.004q) addresses coverage and billing for surgical and minimally invasive treatments for benign prostatic hyperplasia (BPH)-related urinary outlet obstruction. The policy became effective 01/01/2026 and applies to Medicare Advantage plans. The billing team must review specific procedures, prior authorization requirements, and covered treatment modalities to ensure compliant claims submission.
Medium impact
MA11.028l, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Independence Blue Cross·Effective Jan 21, 2026
Policy MA11.028l regarding Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for incontinence control has been reissued effective 01/21/2026. This is a recent policy update (1 month old) that may contain revised coverage criteria, prior authorization requirements, or billing guidance for these neuromodulation procedures. The billing team must review the full policy text to identify specific changes from the previous version and implement any updated prior authorization, documentation, or coding requirements.
Medium impact
MA11.022a, Cryosurgical Ablation of the Prostate Gland
Independence Blue Cross·Effective Jan 21, 2026
Medicare Advantage policy MA11.022a for Cryosurgical Ablation of the Prostate Gland has been reissued with an effective date of January 21, 2026. This is a policy update that will affect coverage and billing for prostate cryosurgical procedures under Medicare Advantage plans.
Medium impact
MA11.101, Nucleoplasty
Independence Blue Cross·Effective Jan 21, 2026
Medicare Advantage policy MA11.101 regarding Nucleoplasty has been reissued with an effective date of January 21, 2026. This is a policy update for a minimally invasive spine procedure, though specific coverage or billing changes are not detailed in the summary.
Medium impact
MA11.079e, Evaluation and Treatment of Erectile Dysfunction (ED)
Independence Blue Cross·Effective Jan 21, 2026
Policy MA11.079e regarding evaluation and treatment of erectile dysfunction was reissued effective January 21, 2026. Without access to the full policy text, the specific changes cannot be determined from the provided information. The billing team must review the complete policy document to identify any new prior authorization requirements, covered/non-covered services, billing code updates, or documentation changes that may affect ED-related claims processing.
Medium impact
MA12.004e, Acupuncture
Independence Blue Cross·Effective Jan 21, 2026
The Medicare Advantage acupuncture policy MA12.004e has been reissued with an effective date of January 21, 2026. This is a policy reissue that may contain updates to coverage criteria, billing requirements, or documentation standards for acupuncture services under Medicare Advantage plans.
Medium impact
MA00.001f, Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests
Independence Blue Cross·Effective Jan 12, 2026
Medicare Advantage has updated their medical policy MA00.001f regarding services that are not medically necessary and diagnostic tests that are obsolete or unreliable. This policy change affects medical necessity criteria and medical coding requirements for Medicare Advantage plans.
Medium impact
MA00.047q, Musculoskeletal Services
Independence Blue Cross·Effective Nov 17, 2025
Medicare Advantage has updated medical necessity criteria for musculoskeletal services effective November 17, 2025. This policy change may affect coverage determination and documentation requirements for orthopedic and related musculoskeletal procedures and services.
Medium impact
MA11.117a, Peroral Endoscopic Myotomy (POEM) Procedures
Independence Blue Cross·Effective Jan 5, 2026
Policy MA11.117a establishes medical coding guidance for Peroral Endoscopic Myotomy (POEM) procedures under Medicare Advantage plans. This recent policy (1 month old) provides updated billing and coding requirements for this advanced endoscopic treatment. The billing team must review and implement any new coding rules or documentation requirements outlined in the full policy text.
Medium impact
MA07.004k, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Independence Blue Cross·Effective Oct 1, 2025
INCOMPLETE POLICY DATA: The provided policy information contains only header/metadata for MA07.004k (Scanning Computerized Ophthalmic Diagnostic Imaging - SCODI) but does not include the actual policy content needed to extract specific billing codes, coverage changes, or actionable requirements. Full policy text must be reviewed to provide accurate billing guidance.
Medium impact
MA09.020v, Radiation Therapy Services (Independence)
Independence Blue Cross·Effective Jan 1, 2026
Independence Blue Cross updated their Medicare Advantage medical necessity criteria for radiation therapy services, effective January 1, 2026. This policy change affects coverage determinations and approval requirements for radiation therapy procedures under MA plans.
Medium impact
MA08.082o, Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars
Independence Blue Cross·Effective Jan 1, 2026
MA08.082o policy updates coverage and medical necessity criteria for four granulocyte-colony stimulating factor (G-CSF) medications: Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®), and related biosimilars, effective January 1, 2026. This is a recent pharmacy policy change that may affect prior authorization requirements, covered indications, or reimbursement terms for these injectable supportive care drugs used primarily in oncology and hematology.
Medium impact
MA08.073u, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·Effective Jan 1, 2026
This recent policy (effective 01/01/2026) updates medical necessity criteria for intravitreal injections of VEGF antagonists, VEGF biosimilars, and combination VEGF/Ang-2 inhibitors used to treat retinal conditions. Billing teams must review and implement new authorization requirements and documentation standards for these pharmacy-administered therapies to ensure claim approval.
Medium impact
MA08.022t, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Independence Blue Cross·Effective Jan 1, 2026
Medicare Advantage updated their policy for Rituximab (Rituxan) infusion, biosimilars, and subcutaneous injection coverage and reimbursement positions, along with medical coding changes. This affects how these cancer and autoimmune medications are billed and covered.
Medium impact
MA08.004z, Coagulation Factors
Independence Blue Cross·Effective Jan 1, 2026
Medicare Advantage policy MA08.004z for Coagulation Factors has been updated with changes to medical necessity criteria, medical coding, and general guidelines. This affects how coagulation factor treatments are covered and billed under Medicare Advantage plans.
Medium impact
MA08.151e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease
Independence Blue Cross·Effective Jan 1, 2026
Policy MA08.151e establishes coverage and medical necessity criteria for monoclonal antibodies directed against amyloid for Alzheimer's disease treatment. This recent policy (effective 01/01/2026) includes updates to coverage positions, reimbursement guidelines, medical coding requirements, and general clinical guidelines for this drug class.
Medium impact
MA11.051c, Treatment of Obesity and Bariatric Surgery for Treatment of Morbid Obesity
Independence Blue Cross·Effective Jan 1, 2026
Policy MA11.051c establishes coverage and reimbursement guidelines for obesity treatment and bariatric surgery procedures under Medicare Advantage plans, effective January 1, 2026. The billing team must review specific coverage criteria, prior authorization requirements, and applicable billing codes to ensure compliant claims submission.
Medium impact
MA08.142e, Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
Independence Blue Cross·Effective Jan 1, 2026
Policy MA08.142e establishes medical necessity criteria for efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo) under Medicare Advantage plans effective January 1, 2026. This policy defines coverage requirements and clinical criteria for these myasthenia gravis treatments.
Medium impact
MA08.044l, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration
Independence Blue Cross·Effective Jan 1, 2026
Medicare Advantage policy MA08.044l has updated medical necessity criteria and medical coding requirements for Eculizumab (Soliris) and related biosimilars, and Ravulizumab-cwvz (Ultomiris) for intravenous administration. This affects specialty infusion billing for these high-cost medications used to treat rare blood disorders.
High impact
MA08.018l, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Independence Blue Cross·Effective Jan 1, 2026
This policy establishes coverage and reimbursement guidelines for trastuzumab (Herceptin®), its biosimilars, and trastuzumab with hyaluronidase-oysk (Herceptin Hylecta) effective January 1, 2026. The billing team must review specific coverage criteria, prior authorization requirements, and reimbursement positions to ensure compliant claim submission for this cancer therapy.
Medium impact
MA08.045o, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
Independence Blue Cross·Effective Jan 1, 2026
Policy MA08.045o updates coverage and medical necessity criteria for Tocilizumab and related biosimilars used for intravenous infusion and subcutaneous injection. This Medicare Advantage policy, effective January 1, 2026, establishes new requirements for when these biologic medications can be covered and reimbursed.
Medium impact
MA11.120, Renal Denervation for Uncontrolled Hypertension
Independence Blue Cross·Effective Oct 28, 2025
MA11.120 is a new Medicare Advantage policy establishing coverage criteria for renal denervation procedures in patients with uncontrolled hypertension. This is the first policy guidance on this procedure; billing teams must understand coverage requirements, prior authorization mandates, and any specific coding or documentation requirements before submitting claims.
Medium impact
MA05.071, Remote Electrical Neuromodulation for Migraines
Independence Blue Cross·Effective Jan 1, 2026
MA05.071 is a new medical policy effective January 1, 2026, establishing coverage criteria and billing guidelines for remote electrical neuromodulation (REN) devices used to treat migraines under Medicare Advantage plans. The billing team must implement this policy immediately to ensure proper claim submission and avoid denials for this newly covered service.

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Archive by year

2023 2024 2025 2026

MA11.023m, Hyaluronan Therapies for Osteoarthritis of the Knee

MA08.023d, Enzyme Replacement for the Treatment of Gaucher's Disease

MA11.004q, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)

MA11.028l, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence

MA11.022a, Cryosurgical Ablation of the Prostate Gland

MA11.101, Nucleoplasty

MA11.079e, Evaluation and Treatment of Erectile Dysfunction (ED)

MA12.004e, Acupuncture

MA00.001f, Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests

MA00.047q, Musculoskeletal Services

MA11.117a, Peroral Endoscopic Myotomy (POEM) Procedures

MA07.004k, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

MA09.020v, Radiation Therapy Services (Independence)

MA08.082o, Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars

MA08.073u, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors

MA08.022t, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)

MA08.004z, Coagulation Factors

MA08.151e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease

MA11.051c, Treatment of Obesity and Bariatric Surgery for Treatment of Morbid Obesity

MA08.142e, Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)

MA08.044l, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration

MA08.018l, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)

MA08.045o, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection

MA11.120, Renal Denervation for Uncontrolled Hypertension

MA05.071, Remote Electrical Neuromodulation for Migraines