26-061m Updates to Medicare Clinical Policies – December 2025
Date: 01/23/26
Review upcoming changes, effective February 9, 2026
The medical policies listed in this update were approved by Centene’s National Medicare Quality Improvement Utilization Management Committee and are effective as of February 2026.
For a complete description of the background, criteria, references and coding implications for these Medicare medical policies, go to the Medicare Prior Authorization Medical Clinical Policies page.
Apply the Medicare National Coverage Decisions (NCDs) and applicable Local Coverage Decisions (LCDs) local policies for primary coverage guidance.
Changes to medical policies, effective February 9, 2026
The following are Medicare clinical policies that have been approved for use. The listed policies are effective February 9, 2026.
Updated Policies | |
|---|---|
Policy number and title | Summary of changes |
MC.CP.MP.108 Allogeneic Hematopoietic Cell Transplants (AHCT) for Sickle Cell Anemia and |
|
MC.CP.MP.108 Allogeneic Hematopoietic Cell Transplants (AHCT) for Sickle Cell Anemia and β-Thalassemia, continued |
|
MC.CP.MP 31 Cosmetic and Reconstructive Procedures |
|
MC.CP.MP.107 Durable Medical Equipment | Policy created. |
MC.CP.CPC.05 Medical Necessity Criteria | Policy developed; adapted from CP.CPC.05. |
Need help? Contact us
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone or through the Health Net provider portal. Behavioral health providers can call 844-966-0298.
Provider Services
Line of business | Phone number | |
|---|---|---|
Medicare (Individual & Employer Group) (Wellcare By Health Net) | ||
Medicare Supplement |
This information applies to Physicians, Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.