What insurance policy changes affect New York providers?

This page tracks changes from major payers (including Medicaid managed care, commercial insurers, and Medicare Advantage plans) that explicitly apply to New York. Changes include prior authorization updates, billing code additions or deletions, and reimbursement rate revisions.

How often are New York policy changes updated?

Our scrapers run daily and publish new findings within 24 hours of detection. Each change includes an effective date where stated so you can prioritize what requires immediate action.

How do I get alerted to new New York insurance policy changes?

Create a free alert on PolicyChanges.app and filter by state to New York. You will receive a daily digest whenever a new matching change is detected.

New York Medicaid & Insurance Policy Updates

New York Insurance & Medicaid Policy Updates

New York providers face a continuous stream of payer policy changes: coverage edits, prior authorization expansions, billing code revisions, and Medicaid reimbursement updates that affect day-to-day practice operations. This page surfaces every tracked policy change that explicitly names New York, so your billing and compliance teams can act before the effective date, not after a claim denial.

High impact

Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation - (Effective Date - 2026-10-15) 7.01.42

Excellus BlueCross BlueShield·Effective Oct 15, 2026

Excellus BlueCross BlueShield has issued a comprehensive new policy (effective October 15, 2026) establishing strict medical necessity criteria for radiofrequency facet joint ablation/denervation procedures. The policy requires prior authorization documentation including: 3+ months of pain, 4+ weeks of conservative treatment, two sequential diagnostic blocks with ≥80% relief, CT/fluoroscopic guidance, and limits on frequency (max 2 per 12 months at same level, minimum 6 months apart). Multiple advanced techniques (pulsed RF, cryoablation, cooled RF, sacroiliac denervation) are classified as investigational and not covered. Sacroiliac joint radiofrequency denervation is explicitly not medically necessary.

[New York] July 2026 Provider Newsletter

[New York] Ensure inpatient facility claims have the correct primary diagnosis: non-reimbursable claims for unacceptable primary diagnosis (PDX) may require resubmission

[New York] Clinical Criteria updates

[New York] Clinical Criteria updates

[New York] Clinical Criteria updates for specialty pharmacy

[New York] Telehealth claims update: ICD-10-CM Excludes1 editing

[New York] Prior authorization and step therapy updates for medications billed under the medical benefit

Medicare: New DME process for select members in multiple states

Highmark’s Telehealth Policy Will Be Updated on Sept. 1

Updated: Corrected Claims Must Be Filed Within 15 Months of Original Claim Finalization Date

[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

HealthHelp Transition: Sign Up for Molecular Lab Prior Auth Training

[New York] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility

[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

[Ohio] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility

[Georgia] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility

[New York] Medical Policy and Clinical Guideline updates effective

[New York] Specialty pharmacy updates — July 2026

Prevent Claim Denials: NY Providers Must Transition to Highmark-EDI by Sept. 30

HealthHelp to Manage Molecular Lab Prior Authorization

[New York] Carelon Medical Benefits Management code updates

[New York] Specialty pharmacy updates — July 2026

Sacroiliac Joint Fusion or Stabilization - (Effective Date - 2026-10-15) 7.01.93

Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation - (Effective Date - 2026-10-15) 7.01.42

Positron Emission Tomography (PET) - Non-Oncologic Applications - (Effective Date - 2026-10-15) 6.01.07

Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty - (Effective Date - 2026-10-15) 6.01.17

Metal-on-Metal Total Hip Resurfacing - (Effective Date - 2026-10-15) 7.01.74

Lysis of Epidural Adhesions - (Effective Date - 2026-10-15) 7.01.73

Lumbar Microdiscectomy - (Effective Date - 2026-10-15) 7.01.98

Lumbar Decompression - (Effective Date - 2026-10-15) 7.01.113

Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure - (Effective Date - 2026-10-15) 1.01.57

Hip Arthroplasty - (Effective Date - 2026-10-15) 7.01.96

Continuous Positive Airway Pressure (CPAP) and Auto-Adjusting Positive Airway Pressure (APAP) Devices - (Effective Date - 2026-10-15) 1.01.06

Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA) - (Effective Date - 2026-10-15) 6.01.34

Reimbursement Update: Massage Therapy CPT Code 97124

Highmark to Perform Hospital OPPS Claim Reviews

[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

Maternity Billing Changes for 2027

New Electronic Remit Regeneration Requests on the eMedNY Website

New York State Medicaid Prescriber Education Program: Free 1.5 Hour Continuing Education on Antibiotic Stewardship

New York State Medicaid Evidence Based Benefit Review Advisory Committee to Review AI-Enabled Devices for Diabetic Retinopathy Screening

Billing for Services Provided to the Office of Mental Health Residential Treatment Facility Residents

Reminder: Medicaid Attestation Required for New York State Medicaid Members Enrolled in Qualifying Clinical Trials

New York State Medicaid Coverage of Basivertebral Nerve Ablation

Increase in Reimbursement for Article 28 Clinic Providers Delivering Mental Health Services

New York State Medicaid Reminder on Documentation and Records Retention Requirements

Childhood Vaccine Counseling

New York State Medicaid Coverage of Breast Cancer Screening, Imaging, and Testing for Management and Treatment