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Mutual News October 2026 Newsletter
Medical Mutual of Ohio·OB-GYN, Psychiatry, Neurology +2 more·Mutual News Newsletter
Effective date
Jan 1, 2027
We identified it
Sep 24, 2026
Summary
Medical Mutual released multiple policy updates effective at staggered dates: new medical policies for debridement and urodynamic testing (effective 2026-12-29), archived the FoundationOne Liquid CDx policy, updated vision therapy to include remote digital software on the investigational/experimental list, removed five VNS CPT/HCPCS codes from behavioral health coverage (codes now align with InterQual database but remain covered for epilepsy), and introduced a new Maternity Care Services Reimbursement Policy (RP-202701) effective 2027-01-01 to replace the current obstetrical policy in response to AMA CPT code revisions.
Action Required
By December 29, 2026: Billing team must stop using CPT codes 61888, 64569, 64570, 95970 and HCPCS codes C1820, C1826, C1827 to edit/reject Vagus Nerve Stimulation claims as investigational/experimental; these codes are deleted from the IE list but VNS remains covered for epilepsy diagnoses—update billing system edits accordingly. By January 1, 2027: Billing team must transition from Obstetrical Care Reimbursement Policy (RP-202002) to new Maternity Care Services Reimbursement Policy (RP-202701) in all billing systems and encounter forms; review new policy on Medmutual.com/Provider/Policies-and-Standards to identify any CPT code or billing requirement changes. Providers should review both policies in advance. Update system rules for maternity care coding to reflect AMA CPT revisions effective January 1, 2027. Also review updated Vision Therapy policy (201103) to recognize remote/online digital vision training software (RevitalVision, Luminopia One) as investigational/experimental. Review updated Reduced and Discontinued Procedures policy (RP-202515) effective January 1, 2027 for new facility UB-04 claim guidelines with Modifier 52.