All Insurance Policy Changes (Page 1242)

Continuing from page 1241. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Low impact
R13833MSP: Creating Additional Medicare Secondary Payer (MSP) Error Codes to Better Identify Incoming MSP Claims that Conflict with MSP Records Found on the Common Working File (CWF)
Medicare/CMS - Transmittals·Identified Jun 18, 2026
This document provides contact information and resources for insurance agents and brokers working with the Health Insurance Marketplace, but does not contain the Medicare Secondary Payer (MSP) error codes policy mentioned in the title. The content appears to be a reference guide for marketplace help desks and websites rather than billing policy changes.
Low impact
R13832CP: July 2026 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Medicare/CMS - Transmittals·Identified Jun 18, 2026
This document provides contact information and resources for insurance agents and brokers working with the Federally-facilitated Marketplace, including help desk phone numbers, email addresses, and useful websites. This is not actually related to the Hospital Outpatient Prospective Payment System (OPPS) despite the misleading title.
Low impact
2026-06-18 - CMS Proposed Rule Locks in Lower Prices & Fosters Innovation for the Medicare Drug Price Negotiation Program
Medicare/CMS·Effective Jan 1, 2029
CMS released a newsletter update highlighting a proposed rule for the Medicare Drug Price Negotiation Program that would establish a permanent framework for lowering drug costs starting in 2029. The newsletter also includes information about PEPPER reports for hospitals and upcoming compliance events.
Medium impact
Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·Effective Aug 3, 2026
Medicare Advantage updated their VEGF injection policy effective August 3, 2026, adding Ranibizumab-leyk (Nufymco®) as covered and establishing a new requirement that inadequate response must be determined after at least 3 monthly injections. The policy maintains a 3-level preferred product hierarchy with bevacizumab as Level 1 preferred.
High impact
Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·Effective Aug 3, 2026
Insurance company has designated bevacizumab as the preferred Level 1 treatment for intravitreal injections, with ranibizumab as Level 2, requiring step therapy and documentation of inadequate response (after 3 monthly injections) before approving higher-tier VEGF antagonists. Ranibizumab-leyk (Nufymco) was added as a covered but non-preferred Level 3 option.
High impact
August 2026 Drug List Change Notification (Commercial)
PacificSource Health Plans·Effective Aug 22, 2026
PacificSource is making significant formulary changes effective August 22, 2026, adding 20+ new drugs to the commercial formulary (mostly tier 2-3 with prior authorization requirements), removing 3 drugs, and updating prior authorization criteria for multiple drug classes including CFTR modulators, ETA receptor antagonists, hereditary angioedema treatments, and oncology agents. State-based plans (OR, ID, MT, WA) have different formulary placements and removals. Billing teams must update systems to enforce new prior auth requirements and quantity limits.
Medium impact
Xenon Scan - RETIRED
Medicare/CMS - NCD·Effective Jun 15, 2026
The Xenon Scan National Coverage Determination has been officially retired by CMS. This means Medicare will no longer provide coverage for xenon scanning procedures, and any related billing codes are no longer valid for Medicare claims.
Medium impact
Vagus Nerve Stimulation (VNS)
Medicare/CMS - NCD·Effective Apr 30, 2026
This is a National Coverage Determination for Vagus Nerve Stimulation (VNS) therapy from Medicare. However, the policy content provided contains only header information without the actual coverage details, billing codes, or specific requirements.
Medium impact
Transcatheter Tricuspid Valve Replacement (TTVR)
Medicare/CMS - NCD·Effective Jun 2, 2026
Medicare has established a new National Coverage Determination (NCD 20.37) for Transcatheter Tricuspid Valve Replacement (TTVR), defining coverage criteria for this cardiac procedure. This creates new billing guidelines and coverage requirements for TTVR procedures under Medicare.
Medium impact
Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)
Medicare/CMS - NCD·Effective Jun 2, 2026
CMS has issued a new National Coverage Determination (NCD 20.38) for Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER). This establishes Medicare coverage criteria for this cardiac procedure, which may require specific documentation and prior authorization requirements.
Medium impact
Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs
Medicare/CMS - NCD·Effective Apr 30, 2026
Medicare has updated National Coverage Determination 210.10 regarding screening for sexually transmitted infections (STIs) and high-intensity behavioral counseling to prevent STIs. This policy affects coverage and billing for STI screening services and preventive counseling under Medicare.
Medium impact
Screening for Hepatitis C Virus (HCV) in Adults
Medicare/CMS - NCD·Effective Apr 7, 2026
This is a National Coverage Determination for Hepatitis C Virus screening in adults under Medicare. However, the policy content provided only contains metadata and header information without the actual coverage criteria, billing codes, or specific requirements.
Medium impact
Renal Denervation (RDN) for Uncontrolled Hypertension
Medicare/CMS - NCD·Effective Mar 24, 2026
CMS has issued a new National Coverage Determination (NCD 20.40) for Renal Denervation (RDN) procedures used to treat uncontrolled hypertension. This establishes Medicare coverage criteria for this specialized cardiovascular procedure.
Medium impact
Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention
Medicare/CMS - NCD·Effective Apr 7, 2026
Medicare has issued a new National Coverage Determination (NCD 210.15) for Pre-Exposure Prophylaxis (PrEP) for HIV Prevention. This establishes coverage criteria and billing guidelines for PrEP services under Medicare, which may affect primary care and infectious disease practices that provide HIV prevention services.
Medium impact
Positron Emission Tomography (FDG) for Oncologic Conditions
Medicare/CMS - NCD·Effective Apr 30, 2026
This is a National Coverage Determination for Positron Emission Tomography (FDG) for oncologic conditions, updated April 30, 2026. Without the full policy text, specific changes cannot be determined, but this affects PET scan billing for cancer patients under Medicare.
High impact
Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Stenosis
Medicare/CMS - NCD·Effective Apr 30, 2026
Medicare has issued National Coverage Determination 150.13 for Percutaneous Image-Guided Lumbar Decompression procedures for Lumbar Spinal Stenosis. This establishes specific coverage criteria for this minimally invasive spinal procedure under Medicare.
Medium impact
Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)
Medicare/CMS - NCD·Effective May 29, 2026
This is a National Coverage Determination establishing Medicare coverage criteria for noninvasive positive pressure ventilation (NIPPV) devices used at home for treating chronic respiratory failure caused by COPD. The policy defines specific medical criteria and documentation requirements that must be met for Medicare to cover these breathing support devices.
Medium impact
Next Generation Sequencing (NGS)
Medicare/CMS - NCD·Effective Apr 30, 2026
This is a National Coverage Determination for Next Generation Sequencing (NGS) from CMS, affecting Medicare coverage policies for genetic testing services. The policy appears to be an update to existing NGS coverage guidelines that will impact billing and coverage requirements for genetic testing procedures.
Medium impact
Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
Medicare/CMS - NCD·Identified Jun 17, 2026
This is a National Coverage Determination for lung cancer screening with Low Dose Computed Tomography (LDCT) from Medicare. However, the policy content provided only contains header information without the actual coverage criteria, billing codes, or specific requirements.
Medium impact
Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management
Medicare/CMS - NCD·Effective Apr 14, 2026
This is a National Coverage Determination for home PT/INR monitoring devices used by patients on anticoagulation therapy. The policy establishes Medicare coverage criteria for home testing equipment and supplies for patients managing blood clotting medications.
Medium impact
Cardiac Contractility Modulation (CCM) for Heart Failure (HF)
Medicare/CMS - NCD·Effective May 29, 2026
Medicare has established a new National Coverage Determination for Cardiac Contractility Modulation (CCM) devices for heart failure treatment. This policy provides specific coverage criteria and billing guidance for CCM procedures that were previously not covered under Medicare.
Medium impact
Aprepitant for Chemotherapy-Induced Emesis
Medicare/CMS - NCD·Effective Apr 30, 2026
This is a National Coverage Determination for Aprepitant, a medication used to prevent chemotherapy-induced nausea and vomiting. The policy establishes Medicare coverage criteria for this anti-emetic drug when used in conjunction with cancer treatment.
High impact
Anti-Cancer Chemotherapy for Colorectal Cancer - RETIRED
Medicare/CMS - NCD·Effective Apr 23, 2026
Medicare's National Coverage Determination 110.17 for Anti-Cancer Chemotherapy for Colorectal Cancer has been RETIRED as of April 23, 2026. This means the specific Medicare coverage guidelines for colorectal cancer chemotherapy under this NCD are no longer in effect, potentially affecting how these treatments are covered and billed.
Medium impact
MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
Medicare/CMS - LCD·Effective Apr 18, 2024
This Local Coverage Determination establishes coverage criteria for lab-developed tests used to identify inherited cancer syndromes in patients who already have cancer. The policy provides specific guidelines for when these genetic tests will be covered by Medicare.
Medium impact
Transcranial Magnetic Stimulation (TMS)
Medicare/CMS - LCD·Effective Mar 26, 2026
This is a new Local Coverage Determination (LCD) for Transcranial Magnetic Stimulation (TMS) from WPS Insurance Corporation, effective March 26, 2026. The policy establishes coverage criteria and billing guidelines for TMS procedures under Medicare Part A and Part B.

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Archive by year

2023 2024 2025 2026

R13833MSP: Creating Additional Medicare Secondary Payer (MSP) Error Codes to Better Identify Incoming MSP Claims that Conflict with MSP Records Found on the Common Working File (CWF)

R13832CP: July 2026 Update of the Hospital Outpatient Prospective Payment System (OPPS)

2026-06-18 - CMS Proposed Rule Locks in Lower Prices & Fosters Innovation for the Medicare Drug Price Negotiation Program

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

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

August 2026 Drug List Change Notification (Commercial)

Xenon Scan - RETIRED

Vagus Nerve Stimulation (VNS)

Transcatheter Tricuspid Valve Replacement (TTVR)

Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)

Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs

Screening for Hepatitis C Virus (HCV) in Adults

Renal Denervation (RDN) for Uncontrolled Hypertension

Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention

Positron Emission Tomography (FDG) for Oncologic Conditions

Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Stenosis

Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)

Next Generation Sequencing (NGS)

Lung Cancer Screening with Low Dose Computed Tomography (LDCT)

Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management

Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

Aprepitant for Chemotherapy-Induced Emesis

Anti-Cancer Chemotherapy for Colorectal Cancer - RETIRED

MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

Transcranial Magnetic Stimulation (TMS)