All PlansCoverageHigh impact
May medical policy updates
Priority Health·MI · ENT (Ear, Nose & Throat), Pulmonology, Cardiology +8 more·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 16, 2026
Summary
Priority Health is implementing extensive medical policy updates effective June 1, 2026, affecting multiple specialties including retirement of apnea monitor and bronchial thermoplasty policies, expanded coverage for balloon sinus procedures, new prior authorization requirements for certain surgeries, and changes to durable medical equipment coverage including making CPM devices no longer covered.
Action Required
By June 1, 2026: Billing teams must update systems to reflect multiple policy changes including: 1) Stop billing apnea monitor services under retired policy #91497 and transition to new billing policy, 2) Remove tobacco use exclusions for eustachian tube balloon dilation, 3) Stop billing bronchial thermoplasty procedures as coverage is discontinued, 4) Add prior authorization requirements for facial scar revisions and computer-assisted surgical navigation for ENT/neurosurgery, 5) Update DME billing to exclude CPM devices for knee arthroplasty and rotator cuff repair as no longer covered, 6) Add HCPCS A7523 to non-covered items list. Update encounter forms and notify providers of expanded coverage criteria for balloon sinus procedures and endoscopic submucosal dissection.