{"id":8872,"date":"2026-03-31T15:37:11","date_gmt":"2026-03-31T15:37:11","guid":{"rendered":"https:\/\/hnetalk.com\/provider\/?p=8872"},"modified":"2026-03-31T15:37:11","modified_gmt":"2026-03-31T15:37:11","slug":"medical-policy-updates-april-2026","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policy-updates-april-2026\/","title":{"rendered":"Medical Policy Updates (April 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
Updates<\/strong><\/td>\n\u00a0Effective Date<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n
Medical Policy<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Concurrent Review Process Update:<\/p>\n

60-Day Provider Notification<\/strong><\/td>\n

06\/01\/2026<\/td>\nThe following Medical Policies are New: <\/u><\/em><\/strong><\/p>\n

Cardiac Contractility Modulation for Heart Failure<\/strong>
\nLine(s) of Business:
\nCommercial, Medicare, Medicaid
\nPolicy Effective Date: 6\/1\/2026<\/p>\n

\u00a0<\/strong>
\nMagnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor<\/strong>
\nLine(s) of Business:
\nCommercial, Medicare, Medicaid
\nPolicy Effective Date: 6\/1\/2026<\/p>\n

 <\/p>\n

The following Medical Policies have Changes: <\/u><\/em><\/strong><\/p>\n

Breast Surgery<\/strong>
\nLine(s) of Business:
\nCommercial, Medicare, Medicaid
\nRevision Effective Date: 6\/1\/2026<\/p>\n

    \n
  • Criteria added for MagTrace\u00ae lymphatic trace<\/li>\n
  • Codes mapping to MagTrace added i.e. 96372 and A9697<\/li>\n
  • No prior authorization required for 96372 and A9697<\/li>\n<\/ul>\n

     <\/p>\n

    Chimeric Antigen Receptor T-Cell Therapy<\/strong>
    \nLine(s) of Business:
    \nCommercial, Medicare, Medicaid
    \nRevision Effective Date: 6\/1\/2026<\/p>\n

      \n
    • Universal Criteria removed<\/li>\n
    • References updated<\/li>\n<\/ul>\n

       <\/p>\n

      Lymphedema – Surgical Treatment<\/strong>
      \nLine(s) of Business:
      \nCommercial, Medicare, Medicaid
      \nRevision Effective Date: 6\/1\/2026<\/p>\n

        \n
      • Prophylactic Lymphovenous Bypass (LVB)\/Lymphovenous anastomosis (LVA) also called LYMPHA is covered with a prior authorization<\/li>\n
      • Coding table updated with 1019T<\/li>\n
      • References updated<\/li>\n<\/ul>\n

         <\/p>\n

        Photochemotherapy (UM460POL)<\/strong>
        \nLine(s) of Business:
        \nCommercial, Medicare, Medicaid
        \nRevision Effective Date: 6\/1\/2026<\/p>\n

          \n
        • Updated language around NCD<\/li>\n<\/ul>\n

           <\/p>\n

          Outpatient Physical and Occupational Therapy<\/strong>
          \nLine(s) of Business:
          \nCommercial, Medicare, Medicaid
          \nRevision Effective Date: 6\/1\/2026<\/p>\n

            \n
          • Criteria updated for Home-based PT and OT services (Policy section: VIII)<\/li>\n<\/ul>\n

             <\/p>\n

            Prostate Procedures (BPH and Prostate Cancer)<\/strong>
            \nLine(s) of Business:
            \nCommercial, Medicare, Medicaid
            \nRevision Effective Date: 6\/1\/2026<\/p>\n

              \n
            • Added CPT 51721, 52443, 55881, 55882 (TULSA) as Experimental\/Investigational<\/li>\n
            • Removed CPT 0421T and added CPT 52597<\/li>\n
            • Added CPT 55868 and 55869<\/li>\n
            • Removed CPT 0006T and added CPT 55877<\/li>\n<\/ul>\n

               <\/p>\n

              Renal Denervation for Uncontrolled Hypertension<\/strong>
              \nLine(s) of Business:
              \nCommercial, Medicare, Medicaid
              \nRevision Effective Date: 6\/1\/2026<\/p>\n

                \n
              • NCA replaced with NCD 20.40<\/li>\n
              • Codes 0935T, C1735 and C1736 added<\/li>\n<\/ul>\n

                 <\/p>\n

                Skin and Soft Tissue Substitutes<\/strong>
                \nLine(s) of Business:
                \nCommercial, Medicare, Medicaid
                \nPolicy Effective Date: 6\/1\/2026<\/p>\n

                  \n
                • Added LCD L39828 and LCA A59712<\/li>\n
                • Added Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404, Q4405, Q4406,<\/li>\n
                • Q4407, Q4408, Q4409, Q4410, Q4411, Q4412, Q4413, Q4414, Q4415, Q4416,<\/li>\n
                • Q4417, Q4420 to the Experimental\/Investigational list<\/li>\n
                • Removed Q4100 and added Q4431, Q4432, Q4433<\/li>\n
                • Removed DermaMatrix (Q4100) and Dermagraft (Q4106)<\/li>\n
                • References updated<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                   <\/p>\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. 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-8872","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-2j6","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8872","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=8872"}],"version-history":[{"count":4,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8872\/revisions"}],"predecessor-version":[{"id":8876,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8872\/revisions\/8876"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8872"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8872"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8872"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}