All Insurance Policy Changes (Page 1323)

Continuing from page 1322. 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
[Ohio] Policy Updates July 2025
CareSource·Effective Sep 1, 2025
CareSource Ohio Medicaid released nine policy updates effective September 1, 2025, including one new medical policy (Autonomic Nerve Testing) and eight revisions across medical and reimbursement categories. The billing team must review each policy individually through CareSource's provider portal to identify specific code changes, coverage modifications, and documentation requirements that may affect claims processing.
Medium impact
[Georgia] Policy Updates August 2025
CareSource·Effective Oct 1, 2025
CareSource Georgia Medicaid released 10 policy updates effective October 1, 2025, including revisions to high-impact policies (Breast Reduction Surgery, Metabolic and Bariatric Surgery, Peripheral Nerve Blocks) and one new reimbursement policy (NICU Level of Care). The billing team must review each linked policy for specific coverage, prior authorization, and documentation changes before the effective date.
Medium impact
[Georgia] Pharmacy Policy Updates August 2025
CareSource·Effective Sep 27, 2025
CareSource Georgia Medicaid is revising pharmacy policies for 47 medications effective September 27, 2025, including new policies for 4 recently FDA-approved drugs (Kisunla, Iqirvo, Leqselvi, Ohtuvayre, and Piasky) and updates to existing specialty drug policies. The billing team must review individual drug policies on CareSource's provider portal to identify specific prior authorization, coverage, and coding changes.
Medium impact
[Indiana] Policy Updates August 2025
CareSource·Effective Oct 1, 2025
CareSource Indiana Medicaid is implementing four policy updates effective October 1, 2025: revisions to Itemized Billing (AD-0865), Medical Record Documentation Standards (AD-0754), and Modifiers (PY-1347), plus a new policy on Urinalysis and Evaluation and Management Services (PY-1606). Billing teams must review each policy detail and update workflows, documentation requirements, billing codes, and prior authorization procedures accordingly.
Medium impact
[Indiana] Pharmacy Policy Updates August 2025
CareSource·Effective Oct 1, 2025
CareSource Indiana Medicaid is updating pharmacy policies for 40 specialty medications effective October 1, 2025. Changes include new policies for 8 medications, revised policies for 17 medications (including prior authorization criteria changes), archived policies that now follow fee-for-service prior authorization, and policies with no clinical criteria updates. Billing teams must review individual medication policies to identify specific prior authorization requirements and coverage changes for affected drugs.
Medium impact
[Ohio] Policy Updates August 2025
CareSource·Effective Oct 1, 2025
CareSource Ohio Medicaid released three policy revisions effective October 1, 2025: Laboratory Testing in Office Setting (PY-1545), Private Duty Nursing (MM-1510), and Readmission–Behavioral Health (AD-1018). This notification announces policy updates without providing specific details; the billing team must access the full policy text via CareSource.com to identify required workflow changes.
Medium impact
[Georgia] September 2025 Policy Updates
CareSource·Effective Nov 1, 2025
CareSource Georgia Medicaid is updating its policy on CPT modifiers 59, XE, XP, XS, and XU effective November 1, 2025. This is a revision to the existing reimbursement policy (PY-1365). The billing team must review the full policy document to understand specific changes to modifier usage and reimbursement rules for Georgia Medicaid claims.
Medium impact
[Georgia] Policy Updates September 2025
CareSource·Effective Oct 1, 2025
CareSource Georgia Medicaid released four policy updates effective October 1–November 1, 2025: revisions to Continuity of Care (administrative), a new policy on Cosmetic and Reconstructive Services (reimbursement), and revisions to Myoelectric Lower Extremity Prosthetic Technology and Noninvasive Home Mechanical Ventilation (medical policies). This notification consolidates monthly policy changes; billing teams must review each policy individually via the CareSource website to identify specific code, coverage, or documentation impacts.
Medium impact
[Indiana] Policy Updates September 2025
CareSource·Effective Nov 1, 2025
CareSource Indiana Medicaid released two medical policy updates effective November 1, 2025: revisions to the Infant Formula policy (MM-1357) and Microwave Ablation of Tumors policy (MM-1482). The document provides notice of these changes and directs providers to review full policy details on CareSource.com, but specific clinical or billing impact details are not included in this notification.
Medium impact
[Ohio] Pharmacy Policy Updates September 2025
CareSource·Effective Oct 1, 2025
CareSource Ohio Medicaid is updating 38 pharmacy policies effective October 1, 2025, including 5 new drug policies (ENCELTO, IMAAVY, ERT for Gaucher Disease, ZEVASKYN, and Medical Benefit Medications), 26 revised policies for specialty medications, and 7 annual reviews with no changes. The majority of changes involve specialty pharmaceuticals for rare diseases, gene therapies, and cell therapies. Billing teams must review individual policy details to identify any prior authorization, coverage restrictions, or documentation requirement changes that may affect claim submission.
Medium impact
[Ohio] Versant Policy Updates September 2025
CareSource·Effective Nov 1, 2025
CareSource has partnered with Versant Health to update vision service policies for Ohio Medicaid members. Two policies—Medically Necessary Contact Lens (1309) and Specialty Spectacle Lens (1330)—are being updated effective November 1, 2025. Billing teams must review the full policy text at the Versant Health website to identify any changes to coverage criteria, billing requirements, or documentation standards.
Medium impact
[Ohio] Policy Updates September 2025
CareSource·Effective Nov 1, 2025
CareSource Ohio Medicaid is releasing 12 policy updates effective November 1, 2025, including 8 medical policy revisions (airway clearance, wound therapy, nursing facility care, nutritional supports, pediatric asthma, tumor ablation, skin substitutes, and transcranial magnetic stimulation), 3 new reimbursement policies (coding guidelines, monitored anesthesia care, and general anesthesia for oral/maxillofacial surgery), and 1 new administrative policy (EPSDT benefit). Billing teams must review each policy individually to identify specific coding, coverage, and documentation requirements.
Medium impact
[Indiana] October 2025 Policy Updates
CareSource·Effective Dec 1, 2025
CareSource Indiana Medicaid is updating reimbursement policies for modifier usage effective December 1, 2025. Two policies are being revised: Modifier 59 (with variants XE, XP, XS, XU) and Modifier 25, which impact how billing teams append modifiers to claims for Indiana Medicaid members.
Medium impact
[Indiana] Versant Policy Updates - October 2025
CareSource·Effective Dec 1, 2025
CareSource/Versant Health has issued updates to two vision service policies for Indiana Medicaid members effective December 1, 2025: Medically Necessary Contact Lenses (Policy 1309) and Specialty Spectacle Lenses (Policy 1330). Billing teams must review the full policy text on the Versant website to understand any changes to coverage criteria, prior authorization requirements, or billing procedures for these vision services.
Medium impact
[Ohio] Policy Updates October 2025
CareSource·Effective Dec 1, 2025
CareSource Ohio Medicaid released three medical policy updates effective December 1, 2025: one new policy for Digital Therapy Devices treating amblyopia (MM-1841) and two revised policies for Peroral Endoscopic Myotomy (MM-1245) and Positive Airway Pressure Device rental (MM-1019). This is a network notification consolidating monthly policy updates; billing teams must review the full policy documents to identify specific coding, coverage, or prior authorization changes.
Medium impact
[Georgia] Avalon Policy Updates - November 2025
CareSource·Effective Jan 1, 2026
CareSource/Avalon is updating 20 laboratory testing policies effective January 1, 2026. These policies govern routine testing management (RTM), a post-service pre-payment clinical claim editing program for Georgia Medicaid. Providers must ensure lab orders comply with updated Avalon policies to avoid claim denials during the RTM review process.
Medium impact
[Georgia] Policy Updates November 2025
CareSource·Effective Jan 1, 2026
CareSource Georgia Medicaid is revising the Behavioral Health Service Frequency Guidelines (PY-1694) effective January 1, 2026. This is a notification that a policy change is coming; the specific clinical or billing impacts cannot be determined from this cover document alone, as the actual policy content details are not provided in the source material.
Low impact
[Indiana] Policy Updates November 2025
CareSource·Effective Jan 1, 2026
CareSource Indiana has issued a November 2025 policy notification announcing consolidated monthly policy updates effective January 1, 2026. This document establishes a predictable policy release cycle for administrative, medical, and reimbursement policies. The specific policy referenced (Overpayment Recovery PY-1111) is listed but the document provided does not contain the full policy details—only a table header indicating it is a reimbursement policy affecting Indiana Medicaid.
Medium impact
[Ohio] Policy Updates November 2025
CareSource·Effective Jan 1, 2026
CareSource Ohio Medicaid released 14 policy updates effective January 1, 2026, including revisions to clinical trial coverage, continuity of care, hospice billing, laboratory testing, overpayment recovery, modifier usage, EDI transactions, and new guidance on venipuncture in outpatient settings. One new policy (Venipuncture PY-1704) was added; the remaining 13 are revisions to existing policies. The billing team must review each updated policy on the CareSource provider portal to identify specific operational changes.
Medium impact
[Georgia] Policy Updates December 2025
CareSource·Effective Feb 1, 2026
CareSource Georgia Medicaid released 8 policy updates effective February 1, 2026, including 1 new policy (Multiple Procedure Payment Reduction for Therapies PY-1428) and 7 revised policies. Changes affect dental services reimbursement, cerumen removal administration, medical necessity determinations, pharmacogenomics testing, safety beds, sentinel events, and special needs car seats. Billing teams must review each policy individually on CareSource.com to identify specific code and workflow impacts.
Medium impact
[Ohio] Pharmacy Policy Updates December 2025
CareSource·Effective Jan 1, 2026
CareSource Ohio Medicaid is updating pharmacy policies for 13 medications effective January 1, 2026, including 10 revised policies, 2 new policies (Sylvant and Yeztugo), 1 archived policy (Yutiq), and 1 revised policy for Gender Identity Hormone Therapy. The specific clinical or billing changes within each policy are not detailed in this notification; billing teams must review individual policy documents to identify prior authorization requirements, coverage criteria, or billing code changes.
Medium impact
[Ohio] Policy Updates December 2025
CareSource·Effective Feb 1, 2026
CareSource Ohio Medicaid is releasing 15 policy revisions effective February 1, 2026, affecting administrative, medical, and reimbursement policies across multiple service categories including orthotic devices, diagnostic testing, obstetrical care, and specialized procedures. The billing team must review each specific policy document to identify exact coverage changes, prior authorization requirements, and documentation updates applicable to your practice.
Medium impact
[Ohio] December 2025 Policy Updates
CareSource·Effective Feb 1, 2026
CareSource Ohio Medicaid released a comprehensive revision to 15 policies effective February 1, 2026, covering administrative, medical, and reimbursement changes. This is a revised notification (originally posted December 1, 2025) with updates highlighted in red. Billing teams must review each specific policy document to identify detailed changes and implement necessary workflow updates before the effective date.
High impact
[Georgia] Pharmacy Policy (Q2 - 2025) Updates January 2026
CareSource·Effective Feb 1, 2026
CareSource Georgia Medicaid is updating pharmacy policies for 47 medications effective February 1, 2026. Most updates are policy revisions affecting existing drugs (botulinum toxins, monoclonal antibodies, ophthalmologic agents, oncology treatments), with 8 new policies added for recently approved medications. Billing teams must review individual drug policies for changes to prior authorization requirements, coverage criteria, and medical necessity documentation.
High impact
[Georgia] Pharmacy Policy (Q3 - 2025) Updates January 2026
CareSource·Effective Feb 1, 2026
CareSource Georgia Medicaid is updating 60+ pharmacy policies effective February 1, 2026, including new coverage for 6 medications (Alyftrek, Attruby, Aucatzyl, Crenessity, Kebilidi, Nemluvio, Niktimvo, Tryngolza), archiving 4 medications (Casgevy, Jesduvroq, Oxbryta, Tegsedi, Zorbtive), and revising coverage criteria for 50+ existing specialty drugs. Billing teams must review each affected medication's specific coverage requirements, prior authorization rules, and medical necessity documentation to ensure accurate claims processing.

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Archive by year

2023 2024 2025 2026

[Ohio] Policy Updates July 2025

[Georgia] Policy Updates August 2025

[Georgia] Pharmacy Policy Updates August 2025

[Indiana] Policy Updates August 2025

[Indiana] Pharmacy Policy Updates August 2025

[Ohio] Policy Updates August 2025

[Georgia] September 2025 Policy Updates

[Georgia] Policy Updates September 2025

[Indiana] Policy Updates September 2025

[Ohio] Pharmacy Policy Updates September 2025

[Ohio] Versant Policy Updates September 2025

[Ohio] Policy Updates September 2025

[Indiana] October 2025 Policy Updates

[Indiana] Versant Policy Updates - October 2025

[Ohio] Policy Updates October 2025

[Georgia] Avalon Policy Updates - November 2025

[Georgia] Policy Updates November 2025

[Indiana] Policy Updates November 2025

[Ohio] Policy Updates November 2025

[Georgia] Policy Updates December 2025

[Ohio] Pharmacy Policy Updates December 2025

[Ohio] Policy Updates December 2025

[Ohio] December 2025 Policy Updates

[Georgia] Pharmacy Policy (Q2 - 2025) Updates January 2026

[Georgia] Pharmacy Policy (Q3 - 2025) Updates January 2026