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Effective January 30, 2026: Clinical Policies

Date: 01/21/26

Superior HealthPlan has updated certain clinical policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on January 30, 2026, at 12:00AM.

Changes in these policies reflect preauthorization requirement amendments that are less burdensome to insureds, physicians, or health care providers.

Policy

Applicable Products

New Policy Overview or Updated Policy Revisions

Hyaluronate Derivatives (Viscosupplementation)

(TX.CP.MP.505)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP

Policy updates include:

  • Added Section II. A. DME Order for ease of use, language copied from current TX.CP.MP.552 DME and Medical Supplies clinical policy with no changes to clinical criteria

Hyperhidrosis Treatments

(CP.MP.62)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

  • Removed “in response to heat exposure or exercise” in description
  • Removed Criteria I.C. Unresponsive or unable to tolerate at least one of the pharmacotherapies prescribed for excessive sweating (e.g., anticholinergics, beta-blockers, or benzodiazepines)
  • Removed six month time frame requirement for trial of conservative management in Criteria I.D
  • Removed note under Criteria III. regarding standard line of medical therapy

 

Obstetrical Home Care Programs

(CP.MP.91)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

  • Under I.E.1.a.i. removed “or unstable”
  • Under I.E.2.a.ii.b. removed “(used only if other quantitative methods not available)”
  • Removed previous criteria II.E. Gestational diabetes clinical management program for oral medications

Orthognathic Surgery

(CP.MP.202)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

  • Changed I.A.2.c. to “with impingement or irritation of buccal or lingual soft tissues of the opposing arch”

Proton and Neutron Beam Therapies

(CP.MP.70)

Ambetter

Policy updates include:

  • Added criteria under I.W. Arteriovenous Malformations (AVM)

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

Prior to updates, Medical Clinical policies are reviewed and approved by the Utilization Management Committee.

For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.