Interferential Current Stimulation

Effective October 1, 2026, service will change from covered to not covered for Medicare Advantage plans. There will be no changes for commercial products. For additional details related to this policy, please click here. 

Epidural Injections for Pain Management

Effective October 1, 2026, prior authorization will continue to be recommended for commercial products but the medical criteria will be revised, which will be found in the online authorization tool only. As a result, this policy will be archived following the effective date of this change. No changes for Medicare Advantage plans. For additional details related to this policy, please click here.

Glucose Monitoring Devices and Supplies

Effective October 1, 2026, the medical policies Glucose Monitoring – Continuous and Glucose Monitoring – Home will be combined into one medical policy, Glucose Monitoring Devices and Supplies. For Medicare Advantage plans only, the brand name will change from One Touch to Abbott based on the revision in the 2026 Evidence of Coverage for Medicare Advantage plans. For additional details related to this policy, please click here.

Maternal Serum Testing for Prediction of Adverse Obstetric Outcomes (formerly known as Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes)

Effective October 1, 2026, the medical policy title will change, as noted above, and the policy statement will be updated; however, with no change in coverage. The service will continue to be not covered for Medicare Advantage Plans and not medically necessary for Commercial Products. For additional details related to this policy, please click here.

Microvolt T-Wave Alternans Testing

Effective October 1, 2026, prior authorization will continue to be recommended for commercial products but the medical criteria will be revised. There will be no changes for Medicare Advantage plans. For additional details related to this policy, please click here.

Removal of Implantable Devices

Effective October 1, 2026, prior authorization will be removed for CPT codes that represent the removal only of implantable devices for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.

New Technology and Miscellaneous Services

Effective October 1, 2026, for Medicare Advantage plans only, CPT code 0935T will change from requiring prior authorization to the need to follow the Centers for Medicare & Medicaid Services (CMS) National and Local Coverage Determinations. There will be no change for commercial products. For additional details related to this policy, please click here.

Enhanced External Counterpulsation (EECP) 

Effective October 1, 2026, HCPCS G0166 will change from not medically necessary for commercial products to having prior authorization recommended for commercial products utilizing the medical criteria in the Enhanced External Counterpulsation (EECP) Medical Policy. There will be no changes for Medicare Advantage plans. For additional details related to this policy, please click here.

Intravitreal and Punctum Corticosteroid Implants 

Effective October 1, 2026, HCPCS codes J7311, J7312, J7313, J7314, J1096, and 68841 will no longer follow the diagnosis edits found in this policy and will be addressed in the Pharmacy-Post Claim Review Medications Payment Policy. For additional details related to this policy, please click here.