MedicaidDocumentationHigh impact
Update for Malnutrition CP.PP.145: Effective November 1, 2026
Ambetter·MI·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
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.
Action Required
Before November 1, 2026: (1) Billing team must update diagnosis code edits in billing software to recognize E44.0 and E44.1 as valid malnutrition codes subject to documentation review. (2) Provider 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. (3) Coding/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. (4) Update 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). Failure to meet documentation requirements will result in claim denial for the cost difference between DRG billed with malnutrition MCC and DRG without.