Bioimpedance Devices for Detection and Management of Lymphedema

Effective March 1, 2026, prior authorization will be required for Medicare Advantage plans and recommended for commercial products utilizing the medical necessity criteria in this policy. Prior to March 1, 2026, services are not covered for Medicare Advantage plans and not medically necessary for commercial products. For additional details related to this policy, please click here.  

Mastectomy Treatment, Breast Reconstruction and Hospital Stays Mandate   

Effective March 1, 2026, ICD-10-CM codes C50.A0 – C50.A2 will be added to the list of diagnoses that will allow physical and occupational therapy services to be reimbursed at no cost share for commercial products. For additional details related to this policy, please click here.  

Multitarget Polymerase Chain Reaction Testing for Diagnosis of Bacterial Vaginosis             

Effective March 1, 2026, for CPT code 81515, ICD-10-CM codes R10.20 – R10.24 will be added to the list of covered diagnoses to replace deleted ICD-10-CM code R10.2 for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.  

Prior Authorization of Services, Treatments, or Procedures

• Effective February 1, 2026, prior authorization will no longer be required for CPT code 57288 for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
• Effective March 1, 2026:

1. Prior authorization will no longer be required for CPT code 67911 for commercial products only. No changes for Medicare Advantage plans.
2. Prior authorization will no longer be required for the following CPT codes when filed with ICD-10-CM C50.A0, C50.A1, C50.A2 for Medicare Advantage plans and commercial products:
   1. Breast Implant Removal: 11971 and 19371
   2. Breast Reconstruction: 11920, 11921, 19316, 19325, 19340, 19342, 19350, 19357, 19361, 19364, 19367 - 19371, 19380 and 19396

For additional details related to this policy, please click here.  

Remote Intraoperative Neurophysiologic (IONP) Monitoring 

Effective March 1, 2026, for CPT code 92133, ICD-10-CM codes H40.841 – H40.843 will be added to the list of covered diagnosis list for Medicare Advantage plans and commercial products. CPT codes 92134 and 92137 will also be added to this policy and will be considered medically necessary only when filed with a covered ICD-10-CM code for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.                                                   

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

Effective March 1, 2026, for CPT code 92133, ICD-10-CM codes H40.841 – H40.843 will be added to the list of covered diagnosis list for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.        

Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy 

Effective March 1, 2026, the medical necessity criteria will be revised for commercial products only. Please refer to the medical policy, Prior Authorization of Services, Treatments or Procedures for Medicare Advantage plans. For additional details related to this policy, please click here.

Focal Treatments for Prostate Cancer                                           

Effective March 1, 2026, CPTs 0601T and 0739T will change from requiring prior authorization to not covered for Medicare Advantage plans. For additional details related to this policy, please click here.  

Low-Level Laser Therapy                                                   

Effective March 1, 2026, for CPT codes 0552T, 97037, S8948, ICD-10-CM codes C50.A0 – C50.A2 will be added to the list of covered diagnosis list for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.  

Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA)                            

Effective February 1, 2026:     

• CPT 0018U, 0026U, 0245U: Authorization will be removed from Medicare Advantage plans and commercial products; service will be covered.
• CPT 0287U, 0552U – 0555U: Medical necessity criteria will be changed to InterQual criteria and will be available in the online authorization tool for participating providers for Medicare Advantage plans and commercial products.  

Effective March 1, 2026:

• CPT 0582U, 0583U, 0585U: Medical necessity criteria will be changed to InterQual criteria and will be available in the online authorization tool for participating providers for Medicare Advantage plans and commercial products.
• CPT 0034U: Medical necessity criteria will be changed to InterQual criteria and will be available in the online authorization tool for participating providers for Medicare Advantage plans.
• CPT 0205U, 0312U: Authorization will be removed from Medicare Advantage plans; service will be not covered.
• CPT 0101U – 01013U, 0129U: ICD-10-CM codes C50.A0 – C50.A2 will be added to the list of covered diagnosis codes for Medicare Advantage plans and commercial products.

For additional details related to this policy, please click here.  

Genetic Testing Services

Effective February 1, 2026:  

• CPT 81546: Authorization will be removed from Medicare Advantage plans and commercial products; service will be covered.
• Afirma BRAF, Afirma MTC, and Rosetta GX Reveal tests will be covered for Medicare Advantage plans and commercial products. Because the services are filed with Unlisted code 81479, authorization is still needed to determine the service provided.

Effective March 1, 2026:     

• CPT 81168: A covered diagnosis edit will be applied to Medicare Advantage plans and commercial products and prior authorization will be removed.
• CPT 81174: Medical necessity criteria will be changed to InterQual criteria and will be available in the online authorization tool for participating providers for Medicare Advantage plans and commercial products. 
• CPT 86316: ICD-10-CM codes C50.A0 – C50.A2 will be added to the list of not covered diagnosis codes for Medicare Advantage plans and not medically necessary diagnosis codes for commercial products.
• CPT 81162 – 81167: ICD-10-CM codes C50.A0 – C50.A2 will be added to the list of covered diagnosis codes for Medicare Advantage plans and to the list of diagnosis codes that do not need authorization for commercial products.
• CPT 81212, 81215 – 81217, 81518 – 81523, 81540: ICD-10-CM codes C50.A0 – C50.A2 will be added to the list of covered diagnosis codes for Medicare Advantage plans and commercial products.

For additional details related to this policy, please click here.  

Esophageal pH Monitoring                           

Effective March 1, 2026, for CPT codes 91034/90135, ICD-10-CM codes P28.30-P28.49 and R05.1-R05.9 will be added to the list of covered diagnosis list for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.