{"id":8807,"date":"2025-12-03T22:00:04","date_gmt":"2025-12-03T22:00:04","guid":{"rendered":"https:\/\/hnetalk.com\/provider\/?p=8807"},"modified":"2025-12-03T22:00:04","modified_gmt":"2025-12-03T22:00:04","slug":"medical-policy-updates-december-2025","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policy-updates-december-2025\/","title":{"rendered":"Medical Policy Updates (December 2025)"},"content":{"rendered":"

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.<\/p>\n

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.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Updates<\/strong><\/td>\n\u00a0Effective Date<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n
Sleep Disordered Breathing Diagnosis and Treatment<\/td>\n02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n
    • For the Medicare line of business, repeat Positive Airway Pressure (PAP) titration study will use InterQual criteria<\/li>\n<\/ul>\n<\/li>\n
    • Added jaw expansion prosthesis as experimental\/ investigational.<\/li>\n
    • Other criteria clarified<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Preimplantation Genetic Testing<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial<\/li>\n<\/ul>\n<\/li>\n
    • Added information regarding PGT-SR to the policy<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Cochlear Implants BAHA (Bone-Anchored Hearing Aid) ABI (Auditory Brainstem Implant) Bone-Conduction Hearing Aid<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • IQ for Cochlear Implantation adopted for Medicaid and Medicare line of business<\/li>\n
    • References updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Tumor Treatment Fields<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • Minor criteria changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Transcatheter Tricuspid Valve Interventions<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • Criteria placed for Commercial and Medicaid line of business with prior authorization<\/li>\n
    • Medicare LOB added NCD 20.38 for Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Transcatheter Mitral Valve Repair<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • IQ criteria adopted for Medicare line of business<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Speech Therapy for Autism Disorders<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • The following was removed from section I Policy Guidelines:\n
        \n
      • Up to sixteen visits may be authorized initially based on review of the documentation and the member\u2019s plan benefits. Additional visits will be authorized based on medical necessity.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Contact Lens (Therapeutic)<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Annual review<\/li>\n
    • No changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Percutaneous Left Atrial Appendage Closure<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • IQ criteria adopted for Commercial and Medicaid<\/li>\n
    • References updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Speech Language Pathology (SLP) Services<\/td>\n02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • The following was removed:\n
        \n
      • Section II Requirements for Initial Determination: Up to sixteen visits may be authorized initially based on review of the documentation and the member\u2019s plan benefits. Additional visits will be authorized based on medical necessity.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Genetic Testing<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • New Policy<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Renal Denervation for Uncontrolled Hypertension<\/p>\n

\u00a0<\/strong><\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • New Policy<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Virtual Cardiac Rehabilitation<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • New Policy<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
PANS\/PANDAS<\/td>\n02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • Annual Review<\/li>\n
    • No changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Dental Anesthesia and Procedures<\/p>\n

 <\/td>\n

01\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • Annual review with no changes<\/li>\n
    • References updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Corneal Remodeling for Refractive Errors<\/p>\n

 <\/td>\n

01\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • Annual review<\/li>\n
    • No changes<\/li>\n
    • Updated references<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Lutetium Therapeutic Radiopharmaceuticals<\/p>\n

 <\/td>\n

02\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business:\n
      \n
    • Commercial, Medicaid, Medicare<\/li>\n<\/ul>\n<\/li>\n
    • Revision<\/li>\n
    • Annual review<\/li>\n
    • No changes<\/li>\n
    • Updated references<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      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. 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 […]<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[],"class_list":["post-8807","post","type-post","status-publish","format-standard","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-2i3","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8807","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=8807"}],"version-history":[{"count":4,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8807\/revisions"}],"predecessor-version":[{"id":8820,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8807\/revisions\/8820"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8807"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8807"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8807"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}