CommercialCoverageHigh impact
Medical and Clinical Policy Updates - Effective October 1, 2026
Sentara Health Plans·Cardiology, Cardiothoracic Surgery, General Surgery +4 more·Medical Policy
Effective date
Oct 1, 2026
We identified it
Jul 7, 2026
Summary
Sentara Health Plans has updated 18 medical policies effective October 1, 2026, including archiving 4 policies (Nasal Repair, Wearable External Cardioverter Defibrillators, Vitrectomy Face-Down Positioning, Computer Assisted Navigation) and revising or reviewing coverage for surgical procedures, DME, and medical devices across cardiac, orthopedic, and dermatologic services. Billing teams must immediately access the full policy text at sentarahealthplans.com and pal.sentarahealthplans.com to identify specific billing code impacts and prior authorization requirement changes for affected procedures.
Action Required
By September 30, 2026: Billing team must access the complete policy details for all 18 updated policies at sentarahealthplans.com and pal.sentarahealthplans.com to identify specific CPT/HCPCS codes affected by each revision. For the 4 archived policies (Surgical 230, DME 24, DME 33, Surgical 233), immediately stop billing associated procedures and determine alternative coverage pathways—claims submitted after October 1, 2026 will be denied. For the 14 revised/reviewed policies affecting cardiac devices (Surgical 126, Surgical 106, DME 63), orthopedic procedures (Surgical 39, Surgical 96, DME 251, DME 21), vascular surgery (Surgical 04), and dermatology (Surgical 03, DME 60), update billing software with new prior authorization requirements and coverage criteria. Update encounter forms and provider guidance documents to reflect changes. Verify prior authorization requirements in the PAL for all affected procedures before claims submission. Failure to comply will result in claim denials and potential payment recoupture.