All Insurance Policy Changes (Page 138)

Continuing from page 137. 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
[Indiana] Save the Date: July 2026 Behavioral Health Live Orientation
CareSource·Identified Jul 1, 2026
CareSource Indiana is hosting a live provider orientation for behavioral health on July 16, 2026. This is an informational event tailored for newly contracted behavioral health providers and care facilities to discuss operational topics and answer questions.
High impact
[Indiana] July 2026 Policy Updates
CareSource·Effective Sep 1, 2026
CareSource Indiana Medicaid released four policy updates effective September 1, 2026, including revisions to modifier usage (Modifier 25 and modifiers 59/XE/XP/XS/XU), dental services billing in facility settings, and infant formula coverage. The billing team must review each policy detail on CareSource.com to understand specific reimbursement rule changes before the effective date.
High impact
[Ohio] July 2026 Policy Updates
CareSource·Effective Sep 1, 2026
CareSource Ohio Medicaid released 12 policy updates effective September 1, 2026 and October 1, 2026, including new reimbursement policies for Applied Behavior Analysis, EKG Interpretations, E/M and Psychotherapy, and dental anesthesia services, plus revisions to existing medical and administrative policies. Billing teams must review each policy individually on the CareSource website to identify specific code changes, documentation requirements, and billing rule updates before the effective dates.
High impact
[Ohio] OAC 5160-13-08, Add-On Payment for Nursing Facility-Based Hemodialysis Furnished by a Dialysis Center
CareSource·Effective Jul 1, 2026
Ohio Medicaid (ODM) has implemented a new add-on payment of $110 per treatment for nursing facility-based hemodialysis services furnished by dialysis centers, effective July 1, 2026. Billing teams must use the designated HD revenue center code with an ODM-specified modifier to claim this add-on payment, which is available only during SFY 2027, for dialysis centers already providing these services, and until the $2.1M budget cap is reached.
High impact
Dental Rate Increase Retro Effective 9/1/2025
Arkansas Medicaid·Effective Sep 1, 2025
Arkansas has implemented a dental rate increase effective retroactively to September 1, 2025. This policy affects dental procedure codes and requires billing teams to update reimbursement rates in their systems to reflect the new fee schedule posted on June 30, 2026.
Medium impact
R530PR1: Section 2231, Regional Medicare Swing-Bed-Rates, updates Table 38 to correct the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2027.  These rates should be used to carve out swing-bed costs
Medicare/CMS - Transmittals·Identified Jul 1, 2026
Failed to analyze policy change
Medium impact
R26P240i: This transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10), by clarifying and revising the existing instructions and by revising existing edits. Effective dates vary.
Medicare/CMS - Transmittals·Identified Jul 1, 2026
Failed to analyze policy change
Medium impact
R13829CP: Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 32.3, Effective October 1, 2026
Medicare/CMS - Transmittals·Identified Jul 1, 2026
Failed to analyze policy change
Medium impact
R13831CP: October 2026 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
Medicare/CMS - Transmittals·Identified Jul 1, 2026
Failed to analyze policy change
Low impact
R13845CP: Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2026 Update
Medicare/CMS - Transmittals·Identified Jul 1, 2026
This policy document contains outdated contact information and resources for Federally-facilitated Marketplace (FFM) agents and brokers. However, the document header claims to be about 'R13845CP: Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2026 Update,' which does NOT match the actual content. This appears to be a misfiled or incorrect document that does not contain Medicare fee schedule updates relevant to medical billing.
Low impact
R13830CP: File Conversions Related to the Spanish Translation of the Healthcare Common Procedure Coding System (HCPCS) DescriptionsI.
Medicare/CMS - Transmittals·Identified Jul 1, 2026
This policy does not affect medical billing operations. The document is a CMS transmittal providing contact information and resources for agents and brokers who assist consumers enrolling in Federally-facilitated Marketplace (FFM) health plans. It contains no billing codes, coverage changes, reimbursement updates, or clinical guidance relevant to healthcare provider billing.
High impact
Texas Health and Human Services Commission Published Fiscal Year 2027 Nursing Facility Liability Insurance Add-On Rate Primary Entity Contact List
Texas Medicaid·Effective Jul 1, 2026
Texas HHSC has transitioned nursing facility liability insurance add-on rate (NFLAR) enrollment to a new web-based system called STEPS (State of Texas Electronic Provider System). Effective July 1, 2026, all nursing facilities must enroll fiscal year 2027 NFLAR through STEPS. Primary Entity Contacts (PECs) must ensure their email addresses match between PEMS and STEPS for enrollment applications to process correctly.
Low impact
LTCR Publishes New Smoke Alarm Requirements for Home and Community-based Services Providers
Texas Medicaid·Identified Jul 1, 2026
LTCR has published new smoke alarm placement requirements for Home and Community-based Services (HCS) providers in Texas. Provider Letter 2026-09 specifies acceptable and non-acceptable smoke alarm locations within HCS homes. This is a compliance and operational requirement, not a billing change.
Medium impact
Second Quarter 2026 HCPCS Updates for Texas Medicaid
Texas Medicaid·Identified Jul 1, 2026
Failed to analyze policy change
Medium impact
Second Quarter 2026 HCPCS Updates for the CSHCN Services Program
Texas Medicaid·Identified Jul 1, 2026
Failed to analyze policy change
High impact
BT2026109: Procedure code 36466 may have reimbursed incorrectly; claims to be adjusted or reprocessed
Indiana Medicaid (IHCP)·Effective Jan 1, 2024
Indiana Health Coverage Programs (IHCP) identified a claim-processing error for procedure code 36466 (injection of chemical agent into multiple incompetent veins with ultrasound guidance). The correct reimbursement rate is $1,316.52 for dates of service January 1, 2024 through April 14, 2026. The FFS system has been updated and affected claims will be mass adjusted or reprocessed; providers should expect adjusted claims on remittance advices beginning August 5, 2026. Providers with MCO-reimbursed claims must contact their respective MCO directly for adjustment.
Medium impact
BT2026110: Coverage and billing information for the July 2026 quarterly HCPCS code update
Indiana Medicaid (IHCP)·Effective Jul 1, 2026
Indiana Health Coverage Programs (IHCP) has issued a July 2026 quarterly HCPCS code update notice establishing that 25+ new procedure codes (CPT 90616, 90639, and HCPCS codes 0631U-0652U) are NONCOVERED effective July 1, 2026. Billing teams should NOT submit claims for these codes until CMS pricing is implemented and IHCP issues a follow-up announcement with final reimbursement details. Claims submitted before pricing is entered into the system may be initially denied and require reprocessing.
High impact
Changes to Renal Dialysis Billing and Payment and Renal Dialysis $95.00 Add-On Payment Per Public Act 103-0593 for Long Term Care Residents
Illinois Medicaid - HFS·Effective Jun 1, 2026
Illinois HFS updated renal dialysis billing effective June 1, 2026, requiring specific revenue codes (0821, 0831, 0841, 0851) with condition codes 74 (home dialysis) or 80 (long-term care). Home-based CAPD/CCPD services now pay at full facility rates instead of 3/7th rate. A new $95.00 add-on payment per treatment day applies for nursing facility residents receiving dialysis; providers must rebill prior claims to receive this add-on.
Medium impact
Directed Payment Calculations on Website
Illinois Medicaid - HFS·Effective Jul 1, 2026
The Illinois Department of Financial and Professional Regulation has posted Directed Payment calculation reports for July through September 2026 on its Hospital Reimbursement Notifications Website. Participating hospitals must access these reports to review their quarterly directed payment amounts and ensure accurate reimbursement reconciliation.
Low impact
Provider Directory Update
CareFirst BlueCross BlueShield·Effective Jun 29, 2026
CareFirst has introduced a new 'Top Specialist' designation in their provider directory for Northern Virginia and DC practitioners. This designation recognizes providers meeting quality, appropriateness, and cost-efficiency criteria and will display next to provider names in the member portal. The billing team should be aware this is a directory/transparency feature with no immediate billing or coding changes required.
High impact
MAB2026063001
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance (MA) program updated prior authorization requirements for COPD agents effective July 6, 2026. New guidelines add clinical criteria for phosphodiesterase 3 and 4 inhibitors (Daliresp/roflumilast and Ohtuvayre/ensifentrine), including documentation of severe/moderate-to-severe COPD diagnosis, chronic bronchitis or dyspnea scores, mental health evaluation requirements, and therapeutic failure of first-line therapies. Renewal approvals now require documented clinical response (exacerbation reduction or improved pulmonary function).
High impact
MAB2026063003
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization requirements for Amyloid-Targeted Monoclonal Antibodies (MABs), effective July 6, 2026. The policy consolidates guidelines for Leqembi (lecanemab-irmb) and Kisunla (donanemab-azbt), removes outdated Aduhelm guidance, and establishes specific clinical criteria including cognitive assessment scores, biomarker confirmation, baseline MRI, dementia specialist prescription, and quarterly monitoring. All prescriptions for these drugs now require prior authorization with documented medical necessity.
High impact
MAB2026063004
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance (MA) program has updated prior authorization requirements for Cytokine and CAM Antagonists effective July 6, 2026. The policy revises clinical review guidelines to increase the length of therapeutic trials of topical corticosteroids and specify potency levels for chronic psoriasis treatment. All prescriptions for these drugs now require prior authorization with detailed documentation of medical necessity, specialist consultation, screening requirements, and disease severity criteria.
High impact
MAb2026063002
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance (MA) program updated prior authorization requirements for antipsychotic medications effective July 6, 2026. New guidelines require prior auth for non-preferred antipsychotics, pediatric prescriptions (under 18), quantity limits exceeded, and therapeutic duplication. Clinical review now mandates FDA-approved or medically accepted indications, appropriate dosing per FDA labeling or peer-reviewed literature, and for children, comprehensive evaluation, specialist involvement, and baseline metabolic monitoring documentation.
Medium impact
Updated Preventive Coverage for Colorectal Cancer Screening to add Colosense® for Medicare Advantage Members (Effective June 8, 2026).
Independence Blue Cross·Effective Jun 8, 2026
Medicare Advantage plans are expanding preventive colorectal cancer screening coverage to include Colosense® (a non-invasive screening technology) effective June 8, 2026. Billing teams must recognize this as a covered preventive service and ensure proper coding and billing without patient cost-sharing.

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Archive by year

2023 2024 2025 2026

[Indiana] Save the Date: July 2026 Behavioral Health Live Orientation

[Indiana] July 2026 Policy Updates

[Ohio] July 2026 Policy Updates

[Ohio] OAC 5160-13-08, Add-On Payment for Nursing Facility-Based Hemodialysis Furnished by a Dialysis Center

Dental Rate Increase Retro Effective 9/1/2025

R530PR1: Section 2231, Regional Medicare Swing-Bed-Rates, updates Table 38 to correct the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2027. &nbsp;These rates should be used to carve out swing-bed costs

R26P240i: This transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10), by clarifying and revising the existing instructions and by revising existing edits. Effective dates vary.

R13829CP: Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 32.3, Effective October 1, 2026

R13831CP: October 2026 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

R13845CP: Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2026 Update

R13830CP: File Conversions Related to the Spanish Translation of the Healthcare Common Procedure Coding System (HCPCS) DescriptionsI.

Texas Health and Human Services Commission Published Fiscal Year 2027 Nursing Facility Liability Insurance Add-On Rate Primary Entity Contact List

LTCR Publishes New Smoke Alarm Requirements for Home and Community-based Services Providers

Second Quarter 2026 HCPCS Updates for Texas Medicaid

Second Quarter 2026 HCPCS Updates for the CSHCN Services Program

BT2026109: Procedure code 36466 may have reimbursed incorrectly; claims to be adjusted or reprocessed

BT2026110: Coverage and billing information for the July 2026 quarterly HCPCS code update

Changes to Renal Dialysis Billing and Payment and Renal Dialysis $95.00 Add-On Payment Per Public Act 103-0593 for Long Term Care Residents

Directed Payment Calculations on Website

Provider Directory Update

MAB2026063001

MAB2026063003

MAB2026063004

MAb2026063002

Updated Preventive Coverage for Colorectal Cancer Screening to add Colosense® for Medicare Advantage Members (Effective June 8, 2026).

R530PR1: Section 2231, Regional Medicare Swing-Bed-Rates, updates Table 38 to correct the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2027. These rates should be used to carve out swing-bed costs