01Already effective Sept.
0230, 2026: Billing team should update the diagnosis set-up in charge entry and on claims for Superior and Ambetter Texas members (Medicaid, CHIP and Ambetter Health products), replacing ICD-10 G35 with G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2 and G35.D, since the source removed G35 from the table.
03Add CPT 59074 to the fetal surgery charge set-up where it applies.
04For caudal or interlaminar epidural steroid injections, providers should document relief and functional movement improvement over three months (the criteria changed from two months), and the old criterion on time since the last ESI is no longer listed.
05For evoked potential testing, providers should document that brainstem auditory evoked potential testing is performed with standard prognostication such as EEG, and the testing timing is now 'after the initial 72 hours.' For fetal surgery, the chart must document the hydropic fetus or risk of hydrops, and a failed round of maternal antenatal corticosteroids unless contraindicated.
06For hospice, billing and intake staff should note that the policy now requires a plan of care, a disease-specific guideline or a decline in clinical status, and the removal of the older five-day approval language for continuous home care and general inpatient care, so do not assume those days are pre-approved.
07Hospice recertification within 180 days needs a renewed terminal illness certification from the hospice medical director, and recertification beyond 180 days also needs a face-to-face encounter documented before the prior period ends.
08A patient who is discharged from hospice and re-elects it needs a new certification period, and any remaining days in the current period are forfeited.
09Front desk and provider staff should be told about these hospice requirements before scheduling recertification.
10Direct questions on prior authorization to Superior at 1-800-218-7508.