High impact
Effective November 30, 2026: Clinical Policies
Ambetter·Effective Nov 30, 2026
Ambetter Health and Superior HealthPlan updated six clinical policies effective November 30, 2026, including new coverage for hematopoietic cell therapy (TREGZI), revised DME coverage removing ankle-foot orthotics and lower extremity prosthetics while adding external sensory prosthetic devices, stricter criteria for sacroiliac joint and nerve root block interventions, and a new policy establishing medical necessity for skin substitute grafts in diabetic foot and venous leg ulcers. Billing teams must immediately identify affected claims and update authorization workflows before the November effective date.