Medicare Advantage Medical Policy Updates

Revised Medical Policies

The following policies/codes are being added to the Prior Authorization list

Medical Policy:  M.3 MA Bioengineered Skin and Soft Tissue Substitutes

Preauthorization Required: Yes

This policy will require prior authorization effective 07/01/2026

Codes: 15011, 15012, 15013, 15014, 15015, 15016, 15017, 15018, 15271, 15272,15273, 15274, 15275, 15276, 15277, A2002, A2003, A2004, A2005, A2006, A2007, A2008, A2009, A2010, A2011, A2012, A2013, A2014, A2015, A2016, A2017, A2018, A2019, A2020, A2021, A2029, A2030, A2031, A2032, A2033, A2034, A2035, A2036, A2037, A2039, A2040, A2041, A2042, A2043, A2045, G0681, G0682, G0683, G0684, A4100, C1832, C1849, C9354, C9356, C9360, C9363, C9364, G0681 G0682 G0683 G0684 Q4100, Q4101, Q4102, Q4103, Q4104, Q4105, Q4106, Q4107, Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4116, Q4117, Q4118, Q4121, Q4122, Q4123, Q4124, Q4125, Q4126, Q4127, Q4128, Q4130, Q4134, Q4135, Q4136, Q4141, Q4142, Q4143, Q4146, Q4147, Q4149, Q4152, Q4158, Q4161, Q4164, Q4165, Q4167, Q4175, Q4182, Q4193, Q4195, Q4196, Q4197, Q4200, Q4202, Q4203, Q4220, Q4226

Medical Policy:  M.14 Amniotic Membrane and Amniotic Fluid

Preauthorization Required: Yes

This policy will require prior authorization effective 07/01/2026

Codes: A2001,  A2035, Q4100, Q4132, Q4133, Q4137, Q4138, Q4139, Q4140, Q4145, Q4148, Q4150, Q4151, Q4153, Q4154, Q4155, Q4156, Q4157, Q4159, Q4160, Q4162, Q4163, Q4168, Q4169, Q4170,  Q4171, Q4173, Q4174, Q4176, Q4177, Q4178, Q4180, Q4181, Q4183- Q4192, Q4194, Q4198, Q4199, Q4201, Q4204, Q4205, Q4206, Q4208, Q4209,  Q4211- Q4221,  Q4225,  Q4227,  Q4229 - Q4242,  Q4245- Q4276,  Q4278, Q4279, Q4280, Q4281, Q4282, Q4283, Q4285 - Q4344,  Q4346  Q4373, Q4375,  Q4376, Q4377, Q4378, Q4379, Q4380, Q4382, Q4383, Q4384, Q4385, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394, Q4395, Q4396, Q4397, V2790, 65778. 65779, 65780

Medical Policy: M.15 Procedures Following NCD, LCD or Interqual

Preauthorization Required: Yes

This policy will require prior authorization effective 07/01/2026

Code: 43842

Medical Policy: M.30 Permanent Cardiac Pacemakers

Preauthorization Required: Yes

This policy will require prior authorization effective 07/01/2026

Code: 33210, 33211, 33212, 33213, 331214, 33274, C1779, C1785, C1786, C1898, C2619, C2620

Medical Policy:  M.34 Orthognathic Surgery

Preauthorization Required: Yes

This policy will require prior authorization effective 07/01/2026

Codes:  21240, 21242, 21243

Medical Policy:  M.36 MA Non Invasive Cerebrovascular and Peripheral Arterial Vascular Studies

Preauthorization Required: Yes

This policy will require prior authorization effective 07/01/2026

Codes: 93880, 93882, 93886, 93888, 93892, 93893, 93895, 93922, 93923, 93924, 93925, 93926, 93930, 93931

Medical Policy: M.37  MA Echocardiogram, Transthoracic (TTE)

Preauthorization Required: Yes

This policy will require prior authorization effective 07/01/2026

Codes: 76376, 76377, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350, 93351, 93352

Medical Policy: M.61 Elective Aorta and Iliac Artery Aneurysm Repair

Preauthorization Required: Yes

This policy will require prior authorization effective 07/01/2026

Codes: 33877, 33880, 33881, 34701, 34702, 34703, 34704, 34705, 34706, 34830, 34831, 34831, 37215, 37216