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Mutual News November 2026 Newsletter
Medical Mutual of Ohio·Oncology, Urology, Dermatology +3 more·Mutual News Newsletter
Effective date
Jan 29, 2027
We identified it
Oct 27, 2026
Summary
Medical Mutual updated multiple medical policies effective November 1, 2026, with changes taking effect 90 days later (January 29, 2027) for material changes. Key updates include: removal of cryoablation coverage for hepatocellular carcinoma, prostate cancer, and renal cell carcinoma with specific CPT codes deleted; policy title revision for peripheral electrical stimulation device (Cala kIQ); deletion of CPT code 31237 and addition of 0373T for behavioral health services; and expansion of ICD-10 diagnosis codes requiring prior authorization review for rosacea treatment.
Action Required
By January 29, 2027: (1) Billing team should remove CPT codes 47371, 47381, 47383, 50250, 50542, and 50593 from cryoablation coverage policies and update billing system rules to use InterQual subsets (Ablative or Transarterial Therapy, Liver, Cryoablation, Prostate and Radiofrequency Ablation or Cryoablation, Renal) for coverage guidance. (2) Update billing system to delete CPT code 31237 and add CPT code 0373T for behavioral health applied behavior analysis (ABA) claims. (3) Modify prior authorization rules in billing software to flag claims with ICD-10 codes L71.1 (Rhinophyma) and L71.8 (Other rosacea) for PA review in addition to existing L71.9 (Rosacea, unspecified) for laser therapy treatment of cutaneous vascular lesions. (4) Remove CPT code 81450 from next-generation sequencing policies and update claim routing to use InterQual subsets for 81450 requests. Failure to implement these changes by the effective date may result in claims being processed under outdated coverage rules or denied due to deleted codes.