2026 May Medical Policy Updates

Effective immediately (May 29, 2026): (1) Billing team must update software to ADD CPT codes 77062 and 77063 for breast cancer screening claims under CAM 089 and CAM 094. (2) REMOVE CPT codes 99401 and 99402 from breastfeeding counseling claims and replace with HCPCS code S9943. (3) ADD seven new compression pump E-codes (E0658, E0678-E0683) to system and update medical necessity requirements per CAM 10118 (now covers lymphedema of chest and trunk). (4) ADD CPT code 0423U for pharmacogenetic testing claims. (5) REMOVE deprecated radiation codes G6015 and G6016 from CAM 80149 (IMRT) and update claims processing. (6) For oncology claims: CAM 80133 now covers HDR temporary prostate brachytherapy as salvage therapy—ensure prior auth and medical necessity templates reflect new indication. (7) For ophthalmology: CAM 90328 now covers epithelium-on corneal collagen products (Epioxa HD, Epioxa)—update formularies. (8) Review CAM 80160 (ECMO) reorganized criteria and ensure providers document shared decision-making. Claims submitted with old codes or missing updated documentation will be denied. Flag CAM 404 (new TMS policy) for detailed review before accepting TMS claims. Coordinate with providers and update all encounter forms, prior auth templates, and fee schedules by June 15, 2026.