ProviderMatters

Medical Policy Updates (February 2026)

Posted on January 30, 2026

Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice. To find policies noted below, please visit healthnewengland.org/Providers/Resources.

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.

 

Updates  Effective Date Notes
Medical Policies  
Bariatric Surgery 04/01/2026
  • All lines of business
  • Added Transoral Outlet Reduction endoscopy (TORe) to Experimental and Investigational (E&I) list
  • Added CPT 43889 and C9784 for TORe to the policy as E&I
  • Added Endoscopic Sleeve Gastrectomy (ESG) to E&I list
  • Definitions updated
Musculoskeletal Surgery: Arthroplasty 04/01/2026
  • All lines of business
  • For all lines of business: Criteria updated for Total Shoulder Arthroplasty, Reverse Shoulder Arthroplasty and Shoulder Hemiarthroplasty
  • For Commercial and Medicaid lines of business: Criteria updated for Total Hip Arthroplasty, Hip Resurfacing Arthroplasty and Total Knee Arthroplasty
  • Policy Guidelines and Definitions updated
Skin and Soft Tissue Substitutes 01/01/2026
  • All lines of business
  • Annual review with no criteria changes
  • Q4395, Q4396, Q4397 Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404
  • Q4405, Q4406, Q4407, Q4408, Q4409, Q4410, Q4411,Q4412, Q4413, Q4414
  • Q4415, Q4416, Q4417, Q4420 to the Experimental/Investigational list effective 1/1/2026
  • Added LCD L39828 and LCA A59712 to policy effective 1/1/2026
  • Removed Q4100 and added Q4431, Q4432, Q4433 effective 1/1/2026
  • Removed DermaMatrix (Q4100) and Dermagraft (Q4106)
  • References updated
Infertility Treatment 04/01/2026
  • Line(s) of Business: Commercial, Medicare
  • Re-formatted and added “Clinical Guidelines” section
Ventricular Assist Devices 04/01/2026
  • All lines of business
  • Annual review with minor criteria changes
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