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June 2026 Clinical Policy Review

The following clinical policies have undergone 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:

Annual Review:

  • CP.MP.120 – Pediatric Liver Transplant
  • CP.MP.129 – Fetal Surgery in Utero for Prenatally Diagnosed Malformations
  • CP.MP.164 – Caudal or Interlaminar Epidural Steroid Injections
  • CP.MP.54 – Hospice Services

Retired Policies:

  • CP.MP.31 – Cosmetic and Reconstructive Surgery (08/10/26)
  • CP.MP.51 – Reduction Mammoplasty and Gynecomastia Surgery (06/18/26)
  • CP.MP.126 – Sacroiliac Joint Fusion (05/11/26)

New Policy:

  • MI.CP.MP.31 – Cosmetic and Reconstructive Surgery

 

These changes go into effect on August 10, 2026 (unless noted otherwise above).
Clinical policies are located on our Clinical & Payment Policy page.

Last Updated: 07/10/2026