M2021 Insurance Policy Changes

Medical and Clinical Policy Updates - Effective August 1, 2026

Sentara Health Plans has updated 57 medical policies effective August 1, 2026, including revisions to surgical procedures (breast, cervical fusion, embolization), DME coverage (chest wall compression, negative pressure wound therapy), and extensive diagnostic testing policies (RTM and GTM). The most significant changes affect PSA testing (revised screening criteria), thyroid disease testing (new cascade approach), and allergen testing (new same-day restriction). Billing teams must review affected policies to ensure accurate coverage determination and prior authorization requirements.