2026 Quarter One Clinical Policy Update

The following clinical policies have undergone an annual review with some added criteria requirements that may impact the prior authorization process. Please see the revision log within each policy to review the changes:

• CP.MP.117 – Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation
• CP.MP.174 – Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy
• CP.MP.180 – Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
• CP.MP.162 – Tandem Transplant

These changes go into effect on June 15, 2026. Clinical policies are located on our Clinical & Payment Policies Page.