Upcoming Policies effective September 7, 2026

By September 7, 2026: (1) Billing team must update prior authorization workflows to enforce ALL new SCS/DRG stimulation criteria: mandatory 6-month conservative management documentation (pharmacologic therapy, physical therapy, and injection therapies), psychological evaluation records, pain level scoring (VAS/NRS ≥5), and 6-week smoking/nicotine cessation verification before claim submission. (2) Providers must include complete documentation in all prior authorization requests for SCS/DRG cases per the Documentation Submission section (diagnosis, clinical history, pain duration/location/level, conservative management details, psychological records, smoking status). (3) Billing team must update system edits to require psychological evaluation documentation and smoking cessation attestation; claims lacking this documentation will be denied. (4) Stop processing any billing for implantable knee shock absorbers (CPT 27870) for any indication and educate providers that these devices are experimental/investigative and non-covered. (5) Remove or inactivate any prior authorization rules tied to policy X-45 (Psychological and Neuropsychological Testing) effective September 7, 2026. (6) Communicate policy changes to providers and ensure encounter forms/templates are updated to prompt for the required documentation elements before submission.