UMR revised its medical policy bulletin for November 2026, adding unproven/not medically necessary language for several services (including photobiomodulation for AMD, CRISPR-based TB plasma testing, Alzheimer's proprietary biomarker and genetic tests, and digital 3D models from surface mesh files) and revising criteria for IRE ablation, BeScreened-CRC, BIOTIA-ID, IVD CAPSULE PSP, histotripsy, external urine management systems, sacral Tarlov cyst surgery (now requiring failure of conservative multidisciplinary management instead of 12 weeks of non-surgical treatment), and meibomian gland procedures. The bulletin's status is revised with an effective date of 2027-01-01 for these coverage guidelines.
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01By 2027-01-01: Billing team should stop submitting the newly unproven services listed in the bulletin (including the Alzheimer's biomarker, CRISPR TB, photobiomodulation, digital 3D model, and meibomian gland codes) for UMR members, and tell providers and front desk staff to avoid scheduling them, since claims for these services will be denied as not medically necessary.
02Update charge entry and claim edits for the revised criteria (IRE, BeScreened-CRC, histotripsy with pancreatic tumors, external urine management HCPCS E2001, Tarlov cyst surgery code 63268 where documentation must show failure of conservative multidisciplinary management, and E1399 with Neosensory removed) and attach supporting documentation to claims where these services are still billed.
03Watch for UMR's next notice for any additional implementation details.
Codes mentioned
838844738417999E2001E139963268
Original notice
Omnibus Codes
uhcprovider.com · Always check the source before changing claims.
Summaries are AI-assisted. Always confirm against the original payer notice.
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