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Effective February 9, 2026: Clinical Policies

Date: 11/06/25

Wellcare By Allwell has created, retired, and approved 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 February 9, 2026, at 12:00AM.

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

AHCT for Sickle Cell Anemia

(MC.CP.MP.108)

Wellcare By Allwell (Medicare)

Policy updates include:

  • Added clarifying language to Criteria I.A.1.b. regarding high risk of stroke
  • Removed first-degree relative donor requirement for cord blood as the source of stem cells for homozygous β-thalassemia in Criteria I.A.2.a.i
  • Removed Criteria I.A.2.d. regarding provider specializing in treating thalassemia
  • Updated verbiage in Note under Criteria I.B. for clarity

Cosmetic and Reconstructive Procedures

(MC.CP.MP.31)

Wellcare By Allwell (Medicare)

Policy updates include:

  • Updated verbiage in Note under Description section for clarity
  • Removed Criteria I.A.4. regarding certain procedures that may be covered if improving appearance is the only benefit

DME

(MC.CP.MP.107)

Wellcare By Allwell (Medicare)

New policy overview:

  • Description of Durable Medical Equipment (DME), Orthotic and Prosthetic Devices, policy guidance based on authoritative sources, and purpose of criteria
  • Policy criteria including equipment specific criteria
  • HCPS codes
  • Coding implications
  • Background

 

Implantable Wireless PAP Monitoring

(MC.CP.MP.150)

Wellcare By Allwell (Medicare)

Retired Policy

 

Lantidra (donislecel) Allogeneic Pancreatic Islet Cellular Therapy

(MC.CP.MP.250)

Wellcare By Allwell (Medicare)

Policy updates include:

  • Annual Review
  • References reviewed and updated

 

Sacroiliac Joint Interventions for Pain Management

(MC.CP.MP.166)

Wellcare By Allwell (Medicare)

Policy updates include:

  • Added “posterior pelvic pain provocation test” to I.D. for clarity
  • Added note to I.E., to clarify the definition of conservative therapy

 

Transplant Service Documentation Requirements

(MC.CP.MP.247)

Wellcare By Allwell (Medicare)

Policy updates include:

  • Updated policy statement I. regarding transplant evaluations by removing “following the first visit for human leukocyte antigen (HLA) typing/donor search and”

To review all policies, please visit Medicare Prior-Authorization Clinical Policies webpage.

Prior to updates, the policies were approved for use by Medicare Quality Committee.

For questions or additional information, please contact Wellcare By Allwell Provider Services at HMO: 1-800-977-7522 DSNP: 1-877-935-8023.