All Insurance Policy Changes (Page 3)

Continuing from page 2. 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
Cryoablation - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
This is a new Medicare Advantage policy defining coverage parameters for cryoablation procedures (also called cryotherapy or cryosurgery), which use extreme cold via liquid nitrogen or argon gas to destroy diseased tissue. The policy applies to both external applications (direct spray/swab) and internal uses (cryoprobe with image guidance). Billing teams must verify patient eligibility under this revised policy and ensure proper documentation of the procedure type and image guidance used.
Medium impact
Comprehensive Genomic Profiling and Multigene Panel Testing for Solid Tumors - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
Failed to analyze policy change
Medium impact
Carpal Tunnel Syndrome Surgical Treatments - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
This Medicare Advantage policy update addresses coverage and billing guidelines for carpal tunnel syndrome surgical treatments, including endoscopic and open carpal tunnel release procedures. The policy outlines the treatment pathway from conservative management to surgical intervention. However, the provided content is incomplete (truncated mid-sentence), limiting a full analysis of specific billing code changes, prior authorization requirements, or coverage modifications.
Medium impact
Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
This is a revised Medicare Advantage policy on Implantable Cardioverter Defibrillators (ICDs) and Cardiac Resynchronization Therapy (CRT) devices. The policy appears to be a clarification or update to existing coverage criteria for these life-saving cardiac devices, but the provided content is incomplete (cut off mid-sentence) and lacks specific billing code guidance, coverage determinations, prior authorization requirements, or effective date information.
Medium impact
Cardiac Electrophysiological Studies and Cardiac Catheter Ablation - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
Failed to analyze policy change
Low impact
Cardiac Catheterization and Coronary Angiography - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
This is a newly updated Medicare Advantage policy describing cardiac catheterization and coronary angiography procedures, including diagnostic techniques for measuring cardiac function and visualizing coronary vessels. However, the policy content provided is descriptive only and does not specify coverage criteria, prior authorization requirements, billing codes, reimbursement rates, or other actionable billing guidance.
Medium impact
Breast Reconstruction - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
This is a new Medicare Advantage policy clarifying coverage for breast reconstruction procedures following mastectomy, trauma, or congenital abnormalities. The policy outlines that reconstruction can be performed immediately, delayed, or in staged fashion and may include revision procedures. However, the policy document provided contains only definitional/scope information without specific billing codes, prior authorization requirements, or coverage limitations that would typically trigger billing workflow changes.
High impact
Breast Excision and Mastectomy - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
This Medicare Advantage policy revision addresses coverage criteria for breast excision and mastectomy procedures, including excisional biopsy and breast-conserving surgery (BCS). The policy clarifies surgical decision-making based on lesion characteristics, size, and clinical context. However, the provided content is truncated and does not include complete coverage criteria, billing codes, or specific reimbursement guidance needed for full implementation.
Medium impact
Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
Failed to analyze policy change
Medium impact
Amtagvi (lifileucel) - Medicare Advantage (Revised)
Humana·Identified Jul 30, 2026
Failed to analyze policy change
Medium impact
Voluntary nationwide recall: Cetirizine (Unique – July)
UPMC Health Plan·Effective Jul 20, 2026
Unique Pharmaceutical Laboratories is voluntarily recalling four specific lots of Cetirizine Hydrochloride Tablets USP 5 mg (lot numbers GY825029, GY825030, GY825031, GY825032) due to cross-contamination with Ranitidine. Affected tablets have red dots and pose a risk of severe allergic reactions in patients sensitive to Ranitidine ingredients. The billing team should alert patients and providers to verify medication lot numbers and coordinate with pharmacies on potential claim adjustments for affected prescriptions.
High impact
Get ready: Steps to take now for our new Provider Portal
Priority Health·Effective Sep 1, 2025
Priority Health is retiring the legacy Prism provider portal on September 1, 2025, and transitioning to a new Provider Portal. All users must register for new accounts immediately, and the billing team should hold non-urgent requests until after September 1 to ensure full visibility and tracking capability in the new system. Critical action: add the 'Remittance Review' staff role to portal accounts to maintain access to historical remittance advices.
High impact
Register now for our new Provider Portal training webinars
Priority Health·Effective Sep 1, 2024
Priority Health's new Provider Portal replaces the legacy Prism system effective September 1, 2024. Billing teams must complete role-specific training webinars by August 31 to ensure uninterrupted access and familiarity with new claims submission, denial dispute, and remittance management workflows in the updated portal.
Medium impact
R13888OTN: Send 'Reason for Denial' Value in Prior Authorization Data to the Integrated Data Repository (IDR)
Medicare/CMS - Transmittals·Identified Jul 30, 2026
Failed to analyze policy change
Medium impact
Reimbursement Rate Updates for MTP and Indian Health Procedure Codes Effective January 1, 2026
Texas Medicaid·Effective Jan 1, 2026
Texas Medicaid is implementing reimbursement rate changes for Medical Transportation Program (MTP) and Indian Health Services procedure codes effective January 1, 2026. Affected claims will be identified and reprocessed by TMHP, with adjustments appearing on future Remittance and Status Reports. Billing teams must access updated fee schedules and verify rates for these services.
Medium impact
Benefit and Prior Authorization Criteria for Eladocagene Exuparvovec-tneq (Kebilidi)
Texas Medicaid·Effective Jul 1, 2026
Texas Medicaid is adding eladocagene exuparvovec-tneq (Kebilidi), a gene therapy for AADC deficiency, as a covered benefit effective July 1, 2026. Prior authorization will be required beginning September 1, 2026, and providers must submit requests using the Special Medical Prior Authorization (SMPA) form. This therapy is limited to one lifetime infusion per patient and requires strict clinical criteria including age 16 months or older, confirmed AADC diagnosis, biallelic DDC gene mutations, and skull maturity documentation.
Medium impact
Benefit and Prior Authorization Information for Allogeneic Processed Thymus Tissue-agdc (Rethymic)
Texas Medicaid·Effective Jul 1, 2026
Texas Medicaid now covers allogeneic processed thymus tissue-agdc (Rethymic) for pediatric patients with congenital athymia effective July 1, 2026, with mandatory prior authorization required beginning September 1, 2026. Billing teams must implement prior authorization workflows using SMPA forms and ensure claims are submitted with procedure code J3590. This is a specialized, rare procedure limited to one lifetime surgical procedure per eligible patient.
Low impact
Upcoming: PEMS Application Enhancements for Providers
Texas Medicaid·Effective Jul 31, 2026
Starting July 31, 2026, TMHP will enhance the PEMS (Provider Enrollment and Management System) with SmartTips and WalkMe walkthroughs to streamline provider enrollment applications. These tools provide field definitions and deficiency correction guidance, reducing application processing times. The phased rollout will be completed by end of 2026.
High impact
HHSC Published an Updated Fiscal Year 2025 Financial Compliance Reports Primary Entity Contacts List
Texas Medicaid·Effective Jul 20, 2026
HHSC has launched the State of Texas Electronic Provider System (STEPS), a new web-based application for Medicaid financial compliance reporting. Texas Medicaid providers must ensure their Primary Entity Contact (PEC) email address is current in PEMS and register in STEPS before July 20, 2026, when FY2025 Financial Compliance Reports collection begins. Financial Compliance Reports will not populate in STEPS unless the PEC email matches between PEMS and STEPS.
High impact
Update to Medicare Waiver Request Requirements and Language
Texas Medicaid·Effective Jul 31, 2026
Effective July 31, 2026, Medicare waiver request requirements and language in PEMS are being updated. Providers who obtain Medicare certification after Medicaid enrollment must now submit a new Medicaid enrollment application within 10 days listing their complete Medicare information. Additionally, providers with existing Medicare waivers who later provide billable services to Medicare clients must immediately enroll in Medicare and resubmit Medicaid enrollment within 10 days. The waiver request certification statements in PEMS have been revised to clarify these obligations and the requirement to bill all applicable non-Medicaid insurances before Medicaid.
High impact
AMA to Update Global Obstetric CPT Code Structure
Medi-Cal·Effective Jan 1, 2027
Effective January 1, 2027, the AMA is replacing the current global obstetric CPT code structure with a disaggregated framework that separately bills antepartum care, labor management, delivery care, and postpartum services. Medi-Cal will align with these changes subject to CMS approval, requiring billing teams to transition from bundled maternity codes to individual service-specific codes.
High impact
[California] Medi-Cal Managed Care enrollment requirements
Anthem BCBS·Effective Sep 1, 2026
Beginning fall 2026, all ordering, referring, and prescribing providers in California must be enrolled with Medi-Cal Managed Care to have eligible prescriptions, referrals, orders, and related claims reimbursed. Providers not directly billing Medi-Cal Managed Care must complete free ORP-only (Ordering/Referring/Prescribing) enrollment through the PAVE website; approval may take 60-180 days depending on provider type.
Medium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (August 2026 Newsletter)
Anthem BCBS·Identified Jul 29, 2026
Failed to analyze policy change
Low impact
[New York] You are invited: immunization measures webinar
Anthem BCBS·Identified Jul 29, 2026
This is an educational webinar invitation from Anthem Blue Cross Blue Shield (New York) regarding HEDIS immunization measures and quality reporting. The webinar on September 2, 2026, is designed to help providers improve vaccination performance rates and overcome vaccine hesitancy. This is informational only and does not represent a billing policy, coverage change, or reimbursement modification.
Medium impact
[New York] Continued collaboration on DRG clinical and coding validation
Anthem BCBS·Effective Jul 23, 2026
Anthem is continuing its DRG clinical and coding validation audit program through its Complex and Clinical Audit (CCA) team and external vendors including Ceris. Your practice should expect ongoing medical record requests and audit correspondence from Anthem and/or its designated vendor partners as part of routine DRG validation activities. The medical record request and audit review processes remain consistent with previous procedures.

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Archive by year

2023 2024 2025 2026

Cryoablation - Medicare Advantage (Revised)

Comprehensive Genomic Profiling and Multigene Panel Testing for Solid Tumors - Medicare Advantage (Revised)

Carpal Tunnel Syndrome Surgical Treatments - Medicare Advantage (Revised)

Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage (Revised)

Cardiac Electrophysiological Studies and Cardiac Catheter Ablation - Medicare Advantage (Revised)

Cardiac Catheterization and Coronary Angiography - Medicare Advantage (Revised)

Breast Reconstruction - Medicare Advantage (Revised)

Breast Excision and Mastectomy - Medicare Advantage (Revised)

Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)

Amtagvi (lifileucel) - Medicare Advantage (Revised)

Voluntary nationwide recall: Cetirizine (Unique – July)

Get ready: Steps to take now for our new Provider Portal

Register now for our new Provider Portal training webinars

R13888OTN: Send 'Reason for Denial' Value in Prior Authorization Data to the Integrated Data Repository (IDR)

Reimbursement Rate Updates for MTP and Indian Health Procedure Codes Effective January 1, 2026

Benefit and Prior Authorization Criteria for Eladocagene Exuparvovec-tneq (Kebilidi)

Benefit and Prior Authorization Information for Allogeneic Processed Thymus Tissue-agdc (Rethymic)

Upcoming: PEMS Application Enhancements for Providers

HHSC Published an Updated Fiscal Year 2025 Financial Compliance Reports Primary Entity Contacts List

Update to Medicare Waiver Request Requirements and Language

AMA to Update Global Obstetric CPT Code Structure

[California] Medi-Cal Managed Care enrollment requirements

[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (August 2026 Newsletter)

[New York] You are invited: immunization measures webinar

[New York] Continued collaboration on DRG clinical and coding validation