Medium impact
Effective July 31, 2026: Clinical Policies
Ambetter·Effective Jul 31, 2026
Superior HealthPlan updated 7 clinical policies effective July 31, 2026, with changes focused on simplifying preauthorization requirements and clarifying medical necessity criteria. Key updates include removal of skin grafting from Burn Surgery policy (redirected to separate policy), removal of CPT codes 15271-15278, updates to neonatal care guidelines (NAS, sepsis, apnea, discharge, phototherapy), and addition of new TMS device option for adolescents. Most changes reduce documentation burden and streamline criteria language rather than expand coverage.