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AmbetterExchange · Documentation · Provider Bulletin · GAHigh impact

Update to Malnutrition (CP.PP.145): Effective September 1, 2026

Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
Aug 26, 2026

Summary

Ambetter from Peach State Health Plan is updating its malnutrition policy (CP.PP.145) effective September 1, 2026. The policy now requires stricter documentation standards for malnutrition diagnoses in acute care hospitalizations, distinguishing between non-severe (moderate) and severe malnutrition with specific diagnosis criteria. Claims billed with malnutrition as a major complication or comorbidity (MCC) will be denied reimbursement unless documentation requirements are met. Two new ICD-10 codes (E44.0 and E44.1) have been added to the policy.

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What to do

by Aug 31, 2026 · 5 steps
01Billing team must review the full CP.PP.145 policy revision log on the Ambetter website to understand updated criteria for moderate and severe malnutrition.
02Update billing software and claim validation rules to recognize new ICD-10 codes E44.0 (non-severe malnutrition) and E44.1 (severe malnutrition).
03Educate inpatient coders and providers on stricter documentation requirements: malnutrition diagnoses in secondary positions (MCC positions) will trigger automatic denials unless physician or licensed independent practitioner documentation clearly supports the diagnosis and meets the new severity-specific criteria.
04Add a pre-claim edit or flag in the billing system to catch malnutrition claims and verify documentation compliance before submission.
05Notify all providers and physician partners of the documentation standards to ensure medical records contain explicit physician documentation supporting malnutrition diagnosis and severity level.
If missed: Failure to comply will result in claim denials for malnutrition billed as MCC.

Codes mentioned

E44.0E44.1

Original notice

Update to Malnutrition (CP.PP.145): Effective September 1, 2026
ambetterhealth.com · Always check the source before changing claims.
View original ↗

Related changes

See all Ambetter changes →
Payment Policy CP.PP.145 MalnutritionMediumEffective Jan 1, 2027 · Claims & BillingUpdate for Malnutrition CP.PP.145: Effective November 1, 2026HighEffective Nov 1, 2026 · Provider BulletinPayment & Clinical Policies Effective Sept 1, 2026HighEffective Sep 1, 2026 · Claims & BillingMalnutrition Policy Revision Policy: Effective September 1, 2026HighEffective Sep 1, 2026 · Provider BulletinBrowse every Ambetter change in the policy list

Related policy hubs

Ambetter policiesGA policy changesCode E44.0Code E44.1

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