All PlansCoverageHigh impact
Medical Policy Updates
MVP Health Care·General Surgery, Cardiology, Plastic Surgery +8 more·Medical Policy
Effective date
Dec 1, 2025
We identified it
Jan 1, 2026
Summary
MVP Health Care has released comprehensive medical policy updates effective December 1, 2025 and January 1, 2026, covering 13 new/revised policies (including rehabilitation, prosthetics, and digital therapeutics) and archiving 7 genetic testing policies that have been consolidated into a new Precision Genetic Testing Management framework. Billing teams must review detailed policy documents to identify coverage changes, prior authorization requirements, and coding impacts for affected services.
Action Required
By January 15, 2026: Billing and clinical teams must obtain and review full policy details for all 13 updated policies (particularly Artificial Intervertebral Discs, BPH Treatments, Breast Reconstruction Surgery, Digital Therapeutics, Hearing Aid Services, HCBS, Penile Implants, and Therapeutic Footwear) from MVP Health Care's Provider FastFax Library. For each policy, identify: (1) prior authorization requirements; (2) covered procedure/device codes; (3) medical necessity documentation requirements; (4) any bundling or frequency limitations. Update billing software, encounter forms, and provider education materials accordingly by January 30, 2026. Immediately discontinue use of archived genetic testing policies (BRCA Testing, Cell Free Fetal DNA, Colorectal Cancer Susceptibility, and others) effective January 1, 2026 and transition to the new Precision Genetic Testing Management Policies. Without these updates, claims may be denied for missing authorizations or use of outdated policy guidance.