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AmbetterExchange · Documentation · Provider Bulletin · MIHigh impact

Update for Malnutrition CP.PP.145: Effective November 1, 2026

Effective date
Nov 1, 2026
Identified
Sep 11, 2026

Summary

Ambetter from Meridian is updating its Malnutrition policy (CP.PP.145) effective November 1, 2026, to include new criteria for both moderate (non-severe) and severe malnutrition diagnoses, along with two new ICD-10 codes (E44.0 and E44.1). The policy requires strict physician documentation to support malnutrition diagnoses billed as major complication/comorbidity (MCC) codes; claims lacking proper documentation will be denied.

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What to do

Action · 5 steps
01Before November 1, 2026.
02Billing team must update diagnosis code edits in billing software to recognize E44.0 and E44.1 as valid malnutrition codes subject to documentation review.
03Provider education team must distribute guidance on new moderate and severe malnutrition criteria to all physicians and licensed independent practitioners involved in inpatient acute care cases.
04Coding/documentation staff must implement retrospective review process to audit inpatient claims with malnutrition as secondary MCC diagnosis, ensuring physician documentation meets new criteria guidelines before claim submission.
05Update encounter documentation templates and EMR/EHR systems to flag malnutrition diagnoses (E44.0, E44.1) as requiring physician attestation that documentation supports diagnosis severity level (moderate vs. severe).
If missed: Failure to meet documentation requirements will result in claim denial for the cost difference between DRG billed with malnutrition MCC and DRG without.

Codes mentioned

E44.0E44.1

Original notice

Update for Malnutrition CP.PP.145: Effective November 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 & BillingPayment & Clinical Policies Effective Sept 1, 2026HighEffective Sep 1, 2026 · Claims & BillingMalnutrition Policy Revision Policy: Effective September 1, 2026HighEffective Sep 1, 2026 · Provider BulletinMalnutrition Policy Provider Notification - Effective 10.1.2026 (PDF)HighEffective Oct 15, 2026 · Claims & BillingBrowse every Ambetter change in the policy list

Related policy hubs

Ambetter policiesMI policy changesCode E44.0Code E44.1

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