What types of policy changes does Sentara Health Plans issue?

Sentara Health Plans regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Sentara Health Plans update its policies?

Sentara Health Plans typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Sentara Health Plans policy changes are tracked here?

This page currently tracks 29 documented Sentara Health Plans policy changes. New items are added as they are identified.

What should I do when Sentara Health Plans changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Sentara Health Plans Policy Changes & Prior Auth Updates

We track 29 documented policy changes from Sentara Health Plans across VA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Sentara Health Plans notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Sentara Health Plans updates automatically.

High impact
Medical and Clinical Policy Updates - Effective July 1, 2026
Sentara Health Plans·Effective Jul 1, 2026
Sentara Health Plans has updated 53 medical policies effective July 1, 2026, affecting surgical procedures, durable medical equipment, behavioral health/substance abuse treatment, cardiac rehabilitation, and other services. Most policies were reviewed for continued applicability; several were revised (including gastrointestinal procedures, BPH treatments, prescription digital therapeutics, wheelchairs, chiropractic services, and ambulatory devices). One policy (TIPSS) was archived and will no longer be covered. Billing teams must verify coverage requirements and prior authorization rules for affected services before the effective date.
High impact
Medical and Clinical Policy Updates - Effective August 1, 2026
Sentara Health Plans·Effective Aug 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.
Medium impact
Medical and Clinical Policy Updates - Effective September 1, 2026
Sentara Health Plans·Effective Sep 1, 2026
Sentara Health Plans has updated 24 medical policies effective September 1, 2026, including reviews, revisions, and archival of existing policies across surgical, behavioral health, medical, and DME categories. Key changes include revised policies for wound treatment supplies, hearing aids/implants, sleep apnea surgery, and diabetes management, plus archival of policies for fetal cardiac imaging, continuous glucose monitoring, insulin pumps, and scalp cooling. Billing teams must identify which policies apply to their patient population and update authorization and coverage rules accordingly.
High impact
Medical and Clinical Policy Updates - Effective June 1, 2026
Sentara Health Plans·Effective Jun 1, 2026
Sentara Health Plans has updated 27 medical policies effective June 1, 2026, including revisions to varicose vein treatment, spinal pain management procedures, electrical stimulation, non-oncology embolization, benign prostatic hyperplasia treatment, and ophthalmic procedures. Additionally, 7 policies have been archived and removed from coverage, including endometrial ablation, left atrial appendage occlusion, and vestibular testing. Billing teams must immediately review affected policies to determine which require prior authorization updates and which procedures are no longer covered.
High impact
Spring 2026 Medical and Clinical Policy Updates
Sentara Health Plans·Effective May 1, 2026
Sentara Health Plans has completed a comprehensive Spring 2026 medical and clinical policy review across January, February, and March 2026. This newsletter announces 73 policy changes affecting medical, surgical, DME, imaging, obstetric, and behavioral health services with multiple effective dates (May 1, June 1, and July 1, 2026). Most policies were either archived (no longer covered), reviewed (coverage confirmed with potential updates), or revised (coverage modified). Billing teams must identify which specific policies affect their practice's services and update systems accordingly before the staggered effective dates.
High impact
Authorization Updates - Effective May 1, 2026
Sentara Health Plans·Effective May 1, 2026
Effective May 1, 2026, Sentara Health Plans is removing prior authorization requirements for 41 diagnostic imaging and cardiac procedure codes that were previously managed by Evolent. These codes across CT, MRI, and echocardiography will no longer require prior authorization or precertification for Medicaid, Medicare, and Commercial products in Virginia. Claims with service dates on or after May 1, 2026 will be automatically reprocessed.
High impact
Medical and Clinical Policy Updates - Effective May 1, 2026
Sentara Health Plans·Effective May 1, 2026
Sentara Health Plans has updated 22 medical policies effective May 1, 2026, with changes spanning surgical procedures, imaging services, DME, and clinical treatments. Key changes include: 12 policies archived (no longer covered), 7 policies revised (coverage criteria or requirements changed), and 3 policies reviewed (clarification without coverage changes). Billing teams must immediately audit claims for archived policies and stop billing those services; for revised policies, documentation and authorization requirements may have changed.
High impact
Medical and Clinical Policy Updates - Effective April 1, 2026
Sentara Health Plans·Effective Apr 1, 2026
Sentara Health Plans is implementing multiple medical policy updates effective April 1, 2026, including revisions to prior authorization procedures, adoption of new advanced imaging guidelines, archival of the Genetic and Molecular Testing policy (with transition to OncoHealth and Avalon vendors), and policy updates across observation care, lumbar laminectomy, TIPSS, prescription digital therapeutics, mechanical stretching devices, and radiation treatment. Additionally, effective February 1, 2026, Medical Policy 34 will be archived with authorization responsibilities transitioning to specialized vendors.
High impact
Medical and Clinical Policy Updates - Winter 2026
Sentara Health Plans·Effective Feb 1, 2026
Sentara Health Plans released Winter 2026 medical policy updates affecting multiple service lines with staggered effective dates (February 1 and April 1, 2026). Key changes include archiving Medical 34 (Genetic and Molecular Testing) with routing to OncoHealth or Avalon authorization systems, revising policies for prescription digital therapeutics, orthotics/braces, lumbar laminectomy, and adopting Evolent 2026 Advanced Imaging Guidelines. Billing teams must implement new authorization workflows and update system configurations before effective dates.
High impact
Authorization Updates - Effective January 1, 2026
Sentara Health Plans·Effective Jan 1, 2026
Effective January 1, 2026, Sentara Health Plans is removing prior authorization requirements for 50+ surgical and diagnostic procedures across Medicare Advantage and Medicaid products in Virginia. This eliminates the need for precertification before performing these procedures, streamlining billing workflows and reducing administrative delays for affected specialties.
High impact
Authorization Updates - Effective January 1, 2026
Sentara Health Plans·Effective Jan 1, 2026
Sentara Health Plans is removing prior authorization requirements for 67 specific medical codes effective January 1, 2026, across Medicaid, Medicare, and Commercial products in Virginia. This eliminates pre-certification barriers for common physical therapy, speech-language pathology, gynecological procedures, and other services. Billing teams must update their authorization workflows to reflect these codes no longer require prior auth submission.
High impact
Medical and Clinical Policy Update - Effective December 1, 2025
Sentara Health Plans·Effective Dec 1, 2025
Sentara Health Plans has updated 16 medical policies effective December 1, 2025, including archiving policies (moving to MCG guidelines or other policies), revising existing policies, and reviewing others. Key changes affect spinal surgery procedures (lumbar fusion, discectomy, laminectomy, cervical laminectomy), cardiac procedures (hemodynamic monitoring, mitral valve implantation), and orthopedic surgeries. Billing teams must identify which of these procedures your practice performs and verify updated coverage criteria and prior authorization requirements through the updated Prior Authorization List (PAL).
High impact
Summer 2025 Authorization Updates
Sentara Health Plans·Effective Jul 1, 2025
Sentara Health Plans has updated 28+ prior authorization policies effective July 1, 2025, with major changes concentrated in behavioral health substance abuse treatment (ASAM levels), ambulatory devices/DME, and bariatric surgery coverage. Most changes involve criteria simplification for Medicaid programs, while some policies are being archived for Commercial plans. Billing teams must immediately review affected codes and update prior authorization requirements in their systems.
Medium impact
Medical Code 64451 Change - Effective June 1, 2026
Sentara Health Plans·Effective Jun 1, 2026
Effective June 1, 2026, Sentara Health Plans will no longer require prior authorization for CPT 64451 (sacroiliac joint nerve injections with image guidance) for Medicaid products in Virginia, up to a limit of 4 dates of service per rolling 12-month period. Claims with dates of service on or after June 1, 2026 will be automatically reprocessed.
Medium impact
Authorization Updates - Effective April 1, 2026
Sentara Health Plans·Identified Mar 13, 2026
Failed to analyze policy change
Medium impact
Authorization Updates - Effective Feb, Mar, April, and May 2026
Sentara Health Plans·Identified Feb 12, 2026
Failed to analyze policy change
Medium impact
Authorization Updates - Effective Feb, March, and May 2026
Sentara Health Plans·Identified Feb 12, 2026
Failed to analyze policy change
Medium impact
Authorization Updates - Effective February 1, 2026
Sentara Health Plans·Identified Jan 12, 2026
Failed to analyze policy change
Medium impact
Authorization Updates - Effective Dec 2025, Jan 2026, and Mar 2026
Sentara Health Plans·Identified Dec 4, 2025
Failed to analyze policy change
Medium impact
Fall 2025 Authorization Updates
Sentara Health Plans·Identified Nov 14, 2025
Failed to analyze policy change
Medium impact
Authorization Updates - Effective February 1, 2026
Sentara Health Plans·Identified Nov 6, 2025
Failed to analyze policy change
Medium impact
Authorization Updates - Effective November 1, 2025
Sentara Health Plans·Identified Aug 19, 2025
Failed to analyze policy change
Medium impact
Authorization Updates - Effective October 1, 2025
Sentara Health Plans·Identified Jul 24, 2025
Failed to analyze policy change
Medium impact
Spring 2025 Authorization Updates
Sentara Health Plans·Identified Jun 9, 2025
Failed to analyze policy change
Medium impact
Authorization Updates - Effective February 1, 2025
Sentara Health Plans·Identified Jun 9, 2025
Failed to analyze policy change
Medium impact
Authorization Updates - Effective March 1, 2025
Sentara Health Plans·Identified Jun 9, 2025
Failed to analyze policy change
Medium impact
Authorization Updates - Effective April 1, 2025
Sentara Health Plans·Identified Jun 9, 2025
Failed to analyze policy change
Medium impact
Authorization Updates - Effective June 1, 2025
Sentara Health Plans·Identified Jun 9, 2025
Failed to analyze policy change
Medium impact
Authorization Updates - Effective August 1, 2025
Sentara Health Plans·Identified May 29, 2025
Failed to analyze policy change

Sentara Health Plans in VA Sentara Health Plans: Anesthesiology Sentara Health Plans: Bariatric Surgery Sentara Health Plans: Cardiology Sentara Health Plans: Cardiothoracic Surgery All payers

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Medical and Clinical Policy Updates - Effective July 1, 2026

Medical and Clinical Policy Updates - Effective August 1, 2026

Medical and Clinical Policy Updates - Effective September 1, 2026

Medical and Clinical Policy Updates - Effective June 1, 2026

Spring 2026 Medical and Clinical Policy Updates

Authorization Updates - Effective May 1, 2026

Medical and Clinical Policy Updates - Effective May 1, 2026

Medical and Clinical Policy Updates - Effective April 1, 2026

Medical and Clinical Policy Updates - Winter 2026

Authorization Updates - Effective January 1, 2026

Authorization Updates - Effective January 1, 2026

Medical and Clinical Policy Update - Effective December 1, 2025

Summer 2025 Authorization Updates

Medical Code 64451 Change - Effective June 1, 2026

Authorization Updates - Effective April 1, 2026

Authorization Updates - Effective Feb, Mar, April, and May 2026

Authorization Updates - Effective Feb, March, and May 2026

Authorization Updates - Effective February 1, 2026

Authorization Updates - Effective Dec 2025, Jan 2026, and Mar 2026

Fall 2025 Authorization Updates

Authorization Updates - Effective February 1, 2026

Authorization Updates - Effective November 1, 2025

Authorization Updates - Effective October 1, 2025

Spring 2025 Authorization Updates

Authorization Updates - Effective February 1, 2025

Authorization Updates - Effective March 1, 2025

Authorization Updates - Effective April 1, 2025

Authorization Updates - Effective June 1, 2025

Authorization Updates - Effective August 1, 2025