{"id":8834,"date":"2026-01-30T22:09:55","date_gmt":"2026-01-30T22:09:55","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8834"},"modified":"2026-02-03T18:17:44","modified_gmt":"2026-02-03T18:17:44","slug":"medical-policy-updates-february-2026","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policy-updates-february-2026\/","title":{"rendered":"Medical Policy Updates (February 2026)"},"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. To find policies noted below, please visit healthnewengland.org\/Providers\/Resources<\/a>.<\/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

 <\/p>\n\n\n\n\n\n\n\n\n\n
Updates<\/strong><\/td>\n\u00a0Effective Date<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n
Medical Policies<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/td>\n<\/tr>\n
Bariatric Surgery<\/td>\n04\/01\/2026<\/td>\n\n
    \n
  • All lines of business<\/li>\n
  • Added Transoral Outlet Reduction endoscopy (TORe) to Experimental and Investigational (E&I) list<\/li>\n
  • Added CPT 43889 and C9784 for TORe to the policy as E&I<\/li>\n
  • Added Endoscopic Sleeve Gastrectomy (ESG) to E&I list<\/li>\n
  • Definitions updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Musculoskeletal Surgery: Arthroplasty<\/td>\n04\/01\/2026<\/td>\n\n
    \n
  • All lines of business<\/li>\n
  • For all lines of business: Criteria updated for Total Shoulder Arthroplasty, Reverse Shoulder Arthroplasty and Shoulder Hemiarthroplasty<\/li>\n
  • For Commercial and Medicaid lines of business: Criteria updated for Total Hip Arthroplasty, Hip Resurfacing Arthroplasty and Total Knee Arthroplasty<\/li>\n
  • Policy Guidelines and Definitions updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Skin and Soft Tissue Substitutes<\/td>\n01\/01\/2026<\/td>\n\n
    \n
  • All lines of business<\/li>\n
  • Annual review with no criteria changes<\/li>\n
  • Q4395, Q4396, Q4397 Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404<\/li>\n
  • Q4405, Q4406, Q4407, Q4408, Q4409, Q4410, Q4411,Q4412, Q4413, Q4414<\/li>\n
  • Q4415, Q4416, Q4417, Q4420 to the Experimental\/Investigational list effective 1\/1\/2026<\/li>\n
  • Added LCD L39828 and LCA A59712 to policy effective 1\/1\/2026<\/li>\n
  • Removed Q4100 and added Q4431, Q4432, Q4433 effective 1\/1\/2026<\/li>\n
  • Removed DermaMatrix (Q4100) and Dermagraft (Q4106)<\/li>\n
  • References updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Infertility Treatment<\/td>\n04\/01\/2026<\/td>\n\n
    \n
  • Line(s) of Business: Commercial, Medicare<\/li>\n
  • Re-formatted and added \u201cClinical Guidelines\u201d section<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Ventricular Assist Devices<\/td>\n04\/01\/2026<\/td>\n\n
    \n
  • All lines of business<\/li>\n<\/ul>\n
      \n
    • Annual review with minor criteria changes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\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. 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 […]<\/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-8834","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-2iu","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8834","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=8834"}],"version-history":[{"count":9,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8834\/revisions"}],"predecessor-version":[{"id":8845,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8834\/revisions\/8845"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8834"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8834"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8834"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}