ProviderMatters

Medical Policy Updates (June 2026)

Posted on May 29, 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.

 

Medical Policy Revisions Effective Date Notes
Ambulatory Electrocardiograph Monitoring August 2026
  • All Lines of Business
  • Minor changes to self-monitoring section
Neurostimulators August 2026
  • All Lines of Business
  • InterQual Medicare Procedure Criteria added for:
    • Spinal stimulation
    • Deep brain and cortical stimulation
    • Sacral nerve stimulation
    • Percutaneous tibial nerve stimulation
    • Vagus nerve stimulation
  • Epicranial focal cortex stimulation added to the policy
  • CPT 64580 added to the coding tables
Percutaneous Neuroablation

 

 August 2026
  • All Lines of Business
  • HNE has adopted InterQual Medicare: Procedures, Facet Joint Interventions for Pain Management NGS for Facet Joint Neuroablation
  • Other minor criteria changes
Peripherally Implanted Nerve Stimulation (PNS), Peripheral Subcutaneous Field Stimulation (PSFS), Percutaneous Electrical Nerve Field Stimulation (PENFS) August 2026
  • All Lines of Business
  • InterQual Medicare: Procedure criteria added for Medicare line of business

 
Transcranial Magnetic Stimulation (TMS) August 2026
  • All Lines of Business
  • Criteria updated with: Evidence of resistance to or inability to tolerate psychopharmacological agents requiring two or more trials of psychopharmacologic agents from at least two different classes of antidepressant medications during current depression episode
New Medical Policy Effective Date Notes
Superficial Radiation Therapy for the Treatment of Nonmelanoma Skin Cancers August 2026
  • All Lines of Business

 

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