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Medicare Advantage internal coverage criteria (plans' public postings) 2026-10-25.2

0 added, 160 changed, 51 retired. Effective 2026-10-25; published 2026-10-26, 9 h after the source.

Changed records

RecordChange
humana:nerve-stimulation-for-urinary-incontinencechanged
humana:neuroablative-techniques-for-chronic-painchanged
humana:noninvasive-tests-for-hepatic-fibrosischanged
humana:nuclear-imaging-for-cancer-indicationschanged
humana:nuclear-imaging-for-noncancer-indicationschanged
humana:obstructive-sleep-apnea-and-other-sleep-related-breathing-disorders-surgical-treatmentschanged
humana:orthognathic-surgerychanged
humana:orthoticschanged
humana:osteochondral-and-subchondral-defects-surgerychanged
humana:outpatient-rehabilitation-skilled-therapychanged
humana:penile-prosthesis-implant-for-erectile-dysfunctionchanged
humana:percutaneous-coronary-interventionchanged
humana:percutaneous-vertebroplasty-kyphoplasty-sacroplastychanged
humana:peripheral-artery-revascularization-of-the-lower-extremitieschanged
humana:peripheral-nerve-stimulatorschanged
humana:pharmacogenomics-testingchanged
humana:pneumatic-compression-deviceschanged
humana:power-wheelchair-accessorieschanged
humana:prostate-radiation-therapy-hypofractionationchanged
humana:prostatectomychanged
humana:prostheticschanged
humana:proton-beam-neutron-beam-and-carbon-ion-radiation-therapychanged
humana:psychiatric-inpatient-hospitalizationchanged
humana:psychiatric-partial-hospital-program-serviceschanged
humana:psychological-and-neuropsychological-testingchanged
humana:radiofrequency-tumor-ablationchanged
humana:recell-autologous-cell-harvesting-devicechanged
humana:rethymic-allogenic-processed-thymus-tissue-agdcchanged
humana:rheumatoid-arthritis-biologic-markers-and-pharmacologic-assessmentchanged
humana:ryoncil-remestemcel-l-rkndchanged
humana:serological-and-fecal-testing-for-inflammatory-bowel-diseasechanged
humana:shoulder-arthroplastychanged
humana:shoulder-arthroscopychanged
humana:single-gene-and-molecular-biomarker-testing-for-solid-tumorschanged
humana:sinonasal-and-eustachian-tube-surgical-procedureschanged
humana:skin-and-tissue-substituteschanged
humana:skysona-elivaldogene-autotemcelchanged
humana:special-stainschanged
humana:spinal-cord-stimulatorschanged
humana:spinal-decompression-surgerychanged
humana:spinal-fusion-surgerychanged
humana:stereotactic-radiosurgery-and-stereotactic-body-radiation-therapychanged
humana:substance-use-disorder-inpatient-serviceschanged
humana:superficial-radiation-therapychanged
humana:tecelra-afamitresgene-autoleucelchanged
humana:temporomandibular-disorderschanged
humana:transcatheter-and-device-based-hemodynamic-management-procedureschanged
humana:transcatheter-peripheral-vascular-stents-chest-abdomen-and-pelvischanged
humana:transcatheter-valve-procedureschanged
humana:transesophageal-and-transthoracic-echocardiographychanged
humana:treatment-of-achalasia-gastroesophageal-reflux-disease-and-hiatal-herniachanged
humana:umbilical-cord-blood-transplantationchanged
humana:upper-and-lower-extremity-computed-tomography-angiography-ctachanged
humana:upper-and-lower-extremity-magnetic-resonance-angiography-venographychanged
humana:upper-and-lower-extremity-magnetic-resonance-imaging-mrichanged
humana:uterine-fibroid-surgical-treatmentschanged
humana:varicose-vein-treatmentschanged
humana:ventricular-assist-device-total-artificial-heartchanged
humana:waskyra-etuvetidigene-autotemcelchanged
humana:zevaskyn-prademagene-zamikeracelchanged
unitedhealthcare:computerized-dynamic-posturographyretired
unitedhealthcare:corneal-topographyretired
unitedhealthcare:cosmetic-reconstructive-proceduresretired
unitedhealthcare:ambulatory-ecg-monitoringretired
unitedhealthcare:ambulatory-eeg-monitoringretired
unitedhealthcare:brow-ptosis-eyelid-repairretired
unitedhealthcare:capsule-endoscopyretired
unitedhealthcare:cardiovascular-diagnostic-proceduresretired
unitedhealthcare:category-iii-cpt-codesretired
unitedhealthcare:clinical-diagnostic-laboratory-servicesretired
unitedhealthcare:deep-brain-responsive-cortical-stimulationretired
unitedhealthcare:dme-prosthetics-appliances-nutritional-supplies-gridretired
unitedhealthcare:ear-nose-throat-proceduresretired
unitedhealthcare:electrical-ultrasonic-stimulatorsretired
unitedhealthcare:experimental-investigational-clinical-trialsretired
unitedhealthcare:gastroesophageal-gastrointestinal-gi-services-proceduresretired
unitedhealthcare:gender-dysphoria-gender-reassignment-surgeryretired
unitedhealthcare:hearing-aids-auditory-implantsretired
unitedhealthcare:hospital-servicesretired
unitedhealthcare:joint-proceduresretired
unitedhealthcare:medicare-part-b-step-therapy-programsretired
unitedhealthcare:medications-drugs-outpatient-partbretired
unitedhealthcare:molecular-path-genetic-test-unlisted-codesretired
unitedhealthcare:molecular-pathology-diagnostics-genetic-testingretired
unitedhealthcare:neurologic-services-proceduresretired
unitedhealthcare:noninvasive-fractional-flow-reserve-ffr-ischemic-heart-diseaseretired
unitedhealthcare:omnibus-codes-mampretired
unitedhealthcare:orthopedic-procedures-devices-productsretired
unitedhealthcare:osteopathic-manipulations-omtretired
unitedhealthcare:pain-management-rehabilitationretired
unitedhealthcare:percutaneous-coronary-interventionsretired
unitedhealthcare:percutaneous-ventricular-assist-deviceretired
unitedhealthcare:pet-scan-myocardial-imagingretired
unitedhealthcare:pharmacogenomics-testingretired
unitedhealthcare:platelet-rich-plasma-therapiesretired
unitedhealthcare:prostate-services-procs-impotence-txretired
unitedhealthcare:radiation-oncologic-proceduresretired
unitedhealthcare:radiologic-diagnostic-proceduresretired
unitedhealthcare:skin-substitues-ctp-injection-applicationretired
unitedhealthcare:sleep-apnea-diagnosis-treatmentretired

Next 100 records

Records are keyed as the API keys them (codes without the dot). JSON: GET /v1/changes?dataset=ma-internal-criteria&version=2026-10-25.2 (Builder plan and up).