New Technology and Miscellaneous Services
Effective August 1, 2026, CPT code 0858T will change from requiring prior authorization for Medicare Advantage plans and not medically necessary for commercial products and not separately reimbursed for professional and institutional providers for Medicare Advantage plans and commercial products to covered but not separately reimbursed for professional and institutional providers for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Blood Product Molecular Antigen Typing
Effective June 1, 2026, CPT codes 0001U and 0084U will continue to require prior authorization; however, the medical criteria for this policy will move from being available in the online authorization tool for participating providers for Medicare Advantage plans and commercial products. Coverage guidance will be available in the medical policy Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA). For additional details related to this policy, please click here.
Autism spectrum disorders mandate
Effective August 1, 2026, this service is not covered for Medicare Advantage plans. For additional details related to this policy, please click here.
Miscellaneous Vascular Embolization Procedures
Effective August 1, 2026, for CPT codes 37242 and 37243, the medical criteria have been revised for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Myoelectric Prosthetic and Orthotic Components for the Upper Limb
Effective August 1, 2026, for A8005 and A8006, these codes will be added to medical policy titled Myoelectric Prosthetic and Orthotic Components for the Upper Limb where it will be not covered for Medicare Advantage plans and not medically necessary for commercial products. For additional details related to this policy, please click here.
Microprocessor-Controlled Prostheses for the Lower Limb
Effective July 1, 2026, L5827 is changing to requiring prior authorization and will be addressed in the Prior Authorization for DME policy. For additional details related to this policy, please click here.
Biomarker Testing Mandate
Effective August 1, 2026:
- CPT code 0032U: Prior authorization will be removed from Medicare Advantage plans and commercial products; service will be not covered for Medicare Advantage plans and not medically necessary for commercial products.
- CPT codes 0034U, 0070U – 0076U, 0286U, 0347U – 0350U, 0434U, 81231, 81232, 81247, 81306, 81350, and 81418: Prior authorization will be removed from Medicare Advantage plans and commercial products, and a covered diagnosis edit will be applied.
- CPT codes 0419U, 81227, 81283, 81374, 81377, 81381, and 81383: A covered diagnosis edit will be applied to Medicare Advantage plans and commercial products.
- CPT codes 81225, 81226, and 81335: The covered diagnosis codes for Medicare Advantage plans and commercial products will be updated.
- CPT code 81328: Prior authorization will be removed from Medicare Advantage plans and not medically necessary denial for ALL diagnosis codes will be removed from commercial products, and a covered diagnosis edit will be applied to both Medicare Advantage plans and commercial products.
- CPT code 81346: Prior authorization will be removed from Medicare Advantage plans and service will be not covered.
- CPT code 81355: Service will be not covered for Medicare Advantage plans and not medically necessary for commercial products.
- CPT codes 81219, 81338, and 81339: Will not require authorization for Medicare Advantage plans and commercial products when filed with 31 ICD-10-CM diagnosis codes in addition to 3 ICD-10-CM diagnosis codes already identified in the policy.
For additional details related to this policy, please click here.
New Technology and Miscellaneous Services
Effective July 1, 2026, prior authorization will be removed from CPT codes 0408T through 0411T and 0415T through 0418T for Medicare Advantage Plans only. For additional details related to this policy, please click here.
Removal of Implantable Devices and Prior Authorization of Treatments, Services or Procedures
Effective July 1, 2026, prior authorization will be removed from CPT codes 0412T through 0414T for Medicare Advantage Plans only. For additional details related to these policies please review the necessary policy.