Coverage policy updates

Policy changes Backwork has recorded, newest first. The most recent change on record is from October 11, 2026. Changes appear here after Backwork reviews and applies a refresh, so this page can trail the payers’ own sites.

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Recorded changes

82,244 on record

Recorded policy changes, newest first
Recorded	Payer	Policy	Change
Sep 30, 2026	AmeriHealth	Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-004	New policy
Sep 30, 2026	AmeriHealth	Steroid-Eluting Sinus Stents and ImplantsPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-107	New policy
Sep 30, 2026	AmeriHealth	Spinal OrthosesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA05-030	New policy
Sep 30, 2026	AmeriHealth	Sleep Disorder Testing and Positive Airway Pressure Therapy Services and SuppliesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA07-058	New policy
Sep 30, 2026	AmeriHealth	Remote Electrical Neuromodulation for MigrainesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA05-071	New policy
Sep 30, 2026	AmeriHealth	Psychiatric Collaborative Care Management (CoCM)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-052	New policy
Sep 30, 2026	AmeriHealth	PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-010	New policy
Sep 30, 2026	AmeriHealth	Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) TherapyPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA06-014	New policy
Sep 30, 2026	AmeriHealth	Peroral Endoscopic Myotomy (POEM) ProceduresPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-117	New policy
Sep 30, 2026	AmeriHealth	Percutaneous Coronary Intervention, Coronary Angiography, and Arterial UltrasoundPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-113	New policy
Sep 30, 2026	AmeriHealth	Pembrolizumab and berahyaluronidase alfa-pmph (KEYTRUDA QLEX)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-189	New policy
Sep 30, 2026	AmeriHealth	Pembrolizumab (Keytruda)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-121	New policy
Sep 30, 2026	AmeriHealth	Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA10-003	New policy
Sep 30, 2026	AmeriHealth	Otoplasty or Non-Surgical External Ear MoldingPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-058	New policy
Sep 30, 2026	AmeriHealth	Orthognathic SurgeryPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-083	New policy
Sep 30, 2026	AmeriHealth	Ocrelizumab (Ocrevus) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-088	New policy
Sep 30, 2026	AmeriHealth	Nusinersen (Spinraza)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-086	New policy
Sep 30, 2026	AmeriHealth	Non-Spinal Osteogenic Stimulators (Electrical and Ultrasonic)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA05-018	New policy
Sep 30, 2026	AmeriHealth	Nivolumab (Opdivo), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-120	New policy
Sep 30, 2026	AmeriHealth	Neuropsychological Testing for Neurologically Based ConditionsPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA07-038	New policy
Sep 30, 2026	AmeriHealth	Musculoskeletal ServicesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-047	New policy
Sep 30, 2026	AmeriHealth	Multiple Surgery Payment ReductionPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-032	New policy
Sep 30, 2026	AmeriHealth	Mogamulizumab-kpkc (Poteligeo)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-102	New policy
Sep 30, 2026	AmeriHealth	Modifiers 26 (Professional Component) and TC (Technical Component)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA03-011	New policy
Sep 30, 2026	AmeriHealth	Medicare Part B vs. Part D Crossover DrugsPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-007	New policy
Sep 30, 2026	AmeriHealth	Medical NecessityPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA12-008	New policy
Sep 30, 2026	AmeriHealth	Measurement of Serum Antibodies to and Measurement of Serum Levels of BiologicsPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA06-019	New policy
Sep 30, 2026	AmeriHealth	Lumasiran (Oxlumo)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-131	New policy
Sep 30, 2026	AmeriHealth	Laser Interstitial Thermal Therapy (LITT)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA07-034	New policy
Sep 30, 2026	AmeriHealth	Lanreotide (Somatuline Depot)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-090	New policy
Sep 30, 2026	AmeriHealth	Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) ProductsPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-030	New policy
Sep 30, 2026	AmeriHealth	Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) InhibitorsPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-073	New policy
Sep 30, 2026	AmeriHealth	High-Technology Radiology ServicesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA09-002	New policy
Sep 30, 2026	AmeriHealth	Facility Reporting of Observation ServicesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-040	New policy
Sep 30, 2026	AmeriHealth	eviCore Lab ManagementPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA06-034	New policy
Sep 30, 2026	AmeriHealth	Endoscopic Submucosal Dissection (ESD)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-118	New policy
Sep 30, 2026	AmeriHealth	Durvalumab (Imfinzi) and Tremelimumab-actl (Imjudo)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-123	New policy
Sep 30, 2026	AmeriHealth	Day RehabilitationPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA10-005	New policy
Sep 30, 2026	AmeriHealth	Daratumumab (Darzalex), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-079	New policy
Sep 30, 2026	AmeriHealth	Corneal Pachymetry Using UltrasoundPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA07-046	New policy
Sep 30, 2026	AmeriHealth	Care Management and Care Planning ServicesPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA00-006	New policy
Sep 30, 2026	AmeriHealth	Bioimpedance for the Detection of LymphedemaPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA07-052	New policy
Sep 30, 2026	AmeriHealth	Atezolizumab (Tecentriq) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-127	New policy
Sep 30, 2026	AmeriHealth	Aqueous Shunts, Minimally Invasive Glaucoma Surgeries (including Microstents), Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA11-105	New policy
Sep 30, 2026	AmeriHealth	Alemtuzumab (Lemtrada)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-015	New policy
Sep 30, 2026	AmeriHealth	Acute Care Facility Inpatient TransfersPayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA12-003	New policy
Sep 30, 2026	AmeriHealth	Ustekinumab for Intravenous InfusionPayerPolicy · AMERIHEALTH-COMMERCIAL-08-00-82	New policy
Sep 30, 2026	AmeriHealth	Treatments for Complex Regional Pain Syndrome (CRPS)PayerPolicy · AMERIHEALTH-COMMERCIAL-08-00-57	New policy
Sep 30, 2026	AmeriHealth	Tocilizumab and Related Biosimilars for Intravenous InfusionPayerPolicy · AMERIHEALTH-COMMERCIAL-08-00-85	New policy
Sep 30, 2026	AmeriHealth	Tildrakizumab-asmn (Ilumya)PayerPolicy · AMERIHEALTH-COMMERCIAL-08-01-48	New policy