October 1, 2026
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted below:
Durable Medical Equipment (DME) / Home Medical Equipment (HME)
- Updated the code list in the embedded link as follows: New codes added effective with dates of service on and after October 1, 2026: E0788 & E2403
Emergency Department Evaluation and Management Level of Service
- Added verbiage to the exclusion section: “Will apply to individual plans effective for dates of service on or after January 1, 2027."
Inpatient Acute Transfers From DRG Hospitals
- Added to the reference section: Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 3, Section 40.2.4 Inpatient Prospective Payment System (IPPS) Transfers Between Hospitals & Chapter 3, Section 20.1.2.4 -Transfers
Routine Test Management Program
- Added verbiage to the exclusion section: “Will apply to individual plans effective for dates of service on or after January 1, 2027."