All Insurance Policy Changes (Page 473)

Continuing from page 472. 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
Prostatic Urethral Lift
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
BCBS Mississippi updated their prostatic urethral lift policy defining specific criteria for medical necessity coverage. The policy establishes clear requirements including failed 6-month medical therapy, prostate size ≤80 mL, specific anatomical criteria, and excludes repeat procedures as investigational.
Medium impact
Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
New medical policy A.7.01.102 establishes coverage criteria for periureteral bulking agents (like Deflux, Vantris, Bulkamid) used to treat vesicoureteral reflux (VUR) in children. This outpatient endoscopic procedure is positioned as an alternative to open surgical repair or long-term antibiotic therapy.
Medium impact
Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
New medical policy establishes coverage criteria for oscillatory devices used to treat cystic fibrosis and chronic diffuse bronchiectasis. High-frequency chest wall compression devices are considered medically necessary only when standard chest physical therapy has failed or is unavailable, while oscillatory positive expiratory pressure devices are covered for patients with hypersecretory lung disease who have difficulty clearing secretions.
Medium impact
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
Blue Cross Blue Shield policy A.1.01.17 classifies both electrical and magnetic pelvic floor stimulation as investigational treatments for urinary and fecal incontinence. Claims using related CPT and HCPCS codes will likely be denied as not medically necessary.
Medium impact
Molecular Markers in Fine Needle Aspirates of the Thyroid
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
This is a new medical policy establishing coverage guidelines for molecular marker testing in thyroid fine needle aspirates. The policy defines when tests like ThyroSeq v3, Afirma Gene Expression Classifier, and other genetic panels are appropriate for patients with indeterminate thyroid nodule cytology results.
Low impact
JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
New medical policy A.2.04.60 establishes coverage criteria for JAK2, MPL, and CALR genetic testing used to diagnose myeloproliferative neoplasms (blood cancers like polycythemia vera, essential thrombocythemia, and primary myelofibrosis). The policy provides detailed background on when these genetic tests are medically necessary but does not specify billing codes or coverage determinations.
Low impact
Acoustic Cardiography
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
This policy confirms that acoustic cardiography (CPT 0716T) and correlated audio-electric cardiography remain investigational and non-covered for diagnosing heart failure and optimizing cardiac resynchronization therapy parameters. The policy was recently updated but maintains the same non-coverage stance established since 2011.
Medium impact
Sleep Disorders
Blue Cross & Blue Shield of Mississippi·Effective Apr 1, 2020
BCBS Mississippi updated their Sleep Disorders policy (L.2.01.415) removing prior authorization requirements for sleep studies performed outside the home setting, effective April 1, 2020. The policy establishes specific criteria for home sleep studies and lists 68 AASM-accredited sleep centers in Mississippi where covered sleep studies must be performed.
Medium impact
Acute and Maintenance Tocolysis
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
Blue Cross Blue Shield of Mississippi updated their tocolysis policy, covering acute therapy with calcium channel blockers, magnesium sulfate, prostaglandin inhibitors, and parenteral terbutaline for preterm labor management. Maintenance tocolytic therapy beyond 48-72 hours is considered investigational and not covered.
Medium impact
Zoladex (goserelin)
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
BCBS Mississippi requires prior authorization for Zoladex (goserelin) with specific medical necessity criteria for breast cancer, prostate cancer, endometriosis, and endometrial thinning. The policy establishes strict approval criteria including age requirements, diagnosis-specific conditions, and treatment duration limits.
Medium impact
Xolair (omalizumab)
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
BCBS Mississippi has updated their prior authorization policy for Xolair (omalizumab), a specialty injectable medication used for asthma, chronic urticaria, nasal polyps, and food allergies. The policy requires prior authorization with specific criteria including age requirements, dosing limits, specialist involvement, and evidence of inadequate response to standard therapies.
Medium impact
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
BCBS Mississippi updated their policy for whole exome sequencing (WES) and whole genome sequencing (WGS) coverage, establishing specific medical necessity criteria for children with unexplained genetic disorders and critically ill infants in ICU settings. The policy considers standard WES medically necessary for unexplained congenital/neurodevelopmental disorders in children when evaluated by genetics specialists, and rapid WES/WGS for critically ill infants with suspected genetic disorders.
Medium impact
Urinalysis
Blue Cross & Blue Shield of Mississippi·Effective Oct 1, 2025
BCBS Mississippi updated their urinalysis policy (L.2.04.418) with new ICD-10 diagnosis codes effective October 1, 2025, including new codes for diabetes complications, metabolic disorders, and pulmonary conditions. The policy maintains the same medical necessity criteria for urinalysis testing but expands the list of covered diagnostic codes.
Medium impact
Thyroid Studies
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
This is a comprehensive thyroid studies policy (L.2.04.416) that establishes medical necessity criteria for thyroid function testing. The policy allows up to 2 thyroid tests per calendar year for stable patients, with more frequent testing permitted when therapy is altered or symptoms are present.
Low impact
Tattooing
Blue Cross & Blue Shield of Mississippi·Effective Oct 1, 2025
BCBS Mississippi updated their tattooing policy to add new ICD-10 diagnosis codes C50.A0, C50.A1, and C50.A2 for malignant inflammatory neoplasm of breast, effective October 1, 2025. These codes can now be used to support coverage for medically necessary tattooing procedures related to breast reconstruction.
Medium impact
State and School Employees' Health Insurance Plan - Zoladex (goserelin)
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
Failed to analyze policy change
Medium impact
State and School Employees' Health Insurance Plan - Xolair (omalizumab)
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
New comprehensive prior authorization policy for Xolair (omalizumab) for State and School Employees' Health Insurance Plan, covering four conditions: chronic spontaneous urticaria, moderate-to-severe persistent asthma, chronic rhinosinusitis with nasal polyps, and food allergies. Detailed eligibility criteria, dosing requirements, and renewal conditions are specified with 6-month approval periods.
Medium impact
State and School Employees' Health Insurance Plan - Lupron (leuprolide acetate)
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
This is a new medical policy for the State and School Employees' Health Insurance Plan covering Lupron (leuprolide acetate) with specific coverage criteria for endometriosis, uterine fibroids, precocious puberty, and prostate cancer. The policy establishes initial approval criteria, limited approval durations (3-6 months), and renewal restrictions for different conditions.
High impact
State and School Employees' Health Insurance Plan - Interleukin-5 Antagonist Monoclonal Antibodies
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
State and School Employees' Health Insurance Plan has established new medical policy criteria for interleukin-5 antagonist monoclonal antibodies (Cinqair, Fasenra, Nucala) used to treat severe eosinophilic asthma, EGPA, hypereosinophilic syndrome, and chronic rhinosinusitis with nasal polyps. The policy establishes detailed prior authorization requirements including specific age restrictions, diagnostic criteria, blood eosinophil count thresholds, and mandatory trial of conventional therapies before approval.
High impact
State and School Employees' Health Insurance Plan - Botulinum Toxin
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
State and School Employees' Health Insurance Plan updated their botulinum toxin policy, specifying that only Botox (onabotulinumtoxinA) is covered for non-cosmetic indications while Dysport, Myobloc, and Xeomin are considered not medically necessary. The policy establishes detailed coverage criteria for overactive bladder, neurogenic bladder, migraine prophylaxis, spasticity, cervical dystonia, and primary axillary hyperhidrosis with specific dosing limits and prior authorization requirements.
Low impact
State and School Employees' Health Insurance Plan - Actimmune (interferon gamma-1b)
Blue Cross & Blue Shield of Mississippi·Effective Oct 1, 2025
The State and School Employees' Health Insurance Plan updated their policy for Actimmune (interferon gamma-1b) with revised approval criteria, corrected terminology from osteoporosis to osteopetrosis, and updated ICD-10 diagnosis codes. The policy now specifies that drug samples cannot be used to satisfy medical necessity requirements and requires specialist consultation.
Medium impact
Speech Therapy
Blue Cross & Blue Shield of Mississippi·Effective Jan 1, 2021
This speech therapy policy update clarifies coverage criteria for pediatric and developmental disorders, requiring test scores below the 20th percentile or 15% age delay for medical necessity. The policy also specifies excluded conditions and maintenance therapy limitations.
Medium impact
Pyrocarbon Metacarpophalangeal and Proximal Interphalangeal Joint Implants
Blue Cross & Blue Shield of Mississippi·Effective Oct 1, 2025
Blue Cross Blue Shield Mississippi updated their policy on pyrocarbon joint implants for hand joints, maintaining that these devices are considered investigational and not covered. New HCPCS codes L6035 and L6036 were added effective 10/01/2025 for prosthetic digits and thumbs.
Medium impact
Plasma Exchange
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
BCBS Mississippi updated their plasma exchange (plasmapheresis) medical policy defining covered versus investigational applications. The policy specifies medical necessity criteria for various autoimmune, hematologic, neurologic, renal diseases and transplantation scenarios, while listing many conditions as investigational (non-covered).
High impact
Oncologic Applications of Positron Emission Tomography (PET) Scanning
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
This policy establishes coverage criteria for PET scans in oncology, specifying when different types of PET imaging are medically necessary versus investigational for various cancer types. The policy details approved radiopharmaceuticals and their specific indications, with particular focus on staging, restaging, and diagnosis applications.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

Prostatic Urethral Lift

Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux

Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions

Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence

Molecular Markers in Fine Needle Aspirates of the Thyroid

JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms

Acoustic Cardiography

Sleep Disorders

Acute and Maintenance Tocolysis

Zoladex (goserelin)

Xolair (omalizumab)

Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders

Urinalysis

Thyroid Studies

Tattooing

State and School Employees' Health Insurance Plan - Zoladex (goserelin)

State and School Employees' Health Insurance Plan - Xolair (omalizumab)

State and School Employees' Health Insurance Plan - Lupron (leuprolide acetate)

State and School Employees' Health Insurance Plan - Interleukin-5 Antagonist Monoclonal Antibodies

State and School Employees' Health Insurance Plan - Botulinum Toxin

State and School Employees' Health Insurance Plan - Actimmune (interferon gamma-1b)

Speech Therapy

Pyrocarbon Metacarpophalangeal and Proximal Interphalangeal Joint Implants

Plasma Exchange

Oncologic Applications of Positron Emission Tomography (PET) Scanning