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Policy Updates

Published Date: Jan. 21, 2026

Highmark Wholecare regularly reviews and updates our policies and procedures. To help you know when policies have been amended, an advanced notification will be provided via our newsletter and posted on our website 60 days prior to the effective date. You can find the medical policy updates at the following links:

Medicaid Provider Updates

Medicare Provider Updates

Policy Updates Effective April 1, 2026

As a reminder, we have updated or reviewed the following Medical Policies, with changes effective April 1^st. These updates will be posted on the Highmark Wholecare provider website on February 2, 2026.

Medicaid Policies:

MP-006-MD-PA Genetic Testing for Cystic Fibrosis - Reformatted ‘Procedures’ section with no changes to clinical criteria/coverage. Updated ‘Summary of Literature’ and ‘Reference Sources’ sections.
MP-010-MD-PA Testing for Genetic Disease - No changes to clinical criteria. Updated ‘Summary of Literature’ section.

Medicare Policies:

MP-094-MC-PA Acupuncture for Chronic Low Back Pain (NCD 30.3.3) - Policy is Retired. InterQual® criteria exists for all procedure codes listed in the ‘Coding Requirements’ section.
MP-096-MC-PA Implantable Continuous Glucose Monitors (I-CGM) (L38617) - Policy Retired. InterQual® criteria exists for all procedure codes listed in ‘Coding Requirements’ section.
MP-097-MC-PA Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (L38495) - Policy to be Retired. InterQual® criteria exists for procedure code listed in ‘Coding Requirements’ section.