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Effective May 29, 2026: Clinical Policies

Date: 05/20/26

Superior HealthPlan and Ambetter from 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 May 29, 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

Diabetic Supplies

(TX.CP.MP.526)

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

Policy updates include:

  • Added Section I DME order from TX.CP.MP.552 with no change to criteria for ease of use
  • Updated Section IV language for policy flow with no change to criteria

 

Durable Medical Equipment and Medical Supplies

(TX.CP.MP.552)

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

Policy updates include:

  • Note added to Section I, A, 2 “Note: Additional "deluxe" features or items that are rented or purchased for aesthetic reasons or added convenience, do not meet the reasonableness test. If a medically necessary, lesser cost item exists and will suit the member/enrollee's medical needs, a higher cost item is not medically necessary”

 

 

Intestinal and Multivisceral Transplant

(CP.MP.58)

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

Policy updates include:

  • Added criteria under II.A.6-II.A.7. Large desmoid tumors and other intra-abdominal tumors with reasonable expectation of posttransplant cure
  • Added retransplantation criteria under III
  • Added CPT codes 44137, 48554

Transplant Service Documentation Requirements

(CP.MP.247)

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

Policy updates include:

  • Updated note under criteria section I. stating “transplant evaluation are effective for six months. After six months have passed, a new authorization is required” to “transplant evaluations are effective for 12 months. After 12 months have passed, a new authorization is required”

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.