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Effective December 31, 2025: Clinical Policies

Date: 11/19/25

Superior HealthPlan has added and 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 December 31, 2025, at 12:00AM.

Policy

Applicable Products

New Policy Overview or Updated Policy Revisions

Durable Medical Equipment and Medical Supplies

(TX.CP.MP.552)

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

Policy updates include:

  • Updated product “MMP” to D-SNP"
  • Added Section I.A.3: “Date last seen by a physician or allowed practitioner must be within:
    • Six months for the initial authorization of service, or
    • Annually for the reauthorization of the same service
  • Moved Section IV to Section I.A.4 for policy flow

Hyaluronate Derivatives (Viscosupplementation)

(TX.CP.MP.505)

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

New Policy Overview:

  • Description
  • Policy and Criteria
  • Background
  • Dosage and Administration
  • Coding Implications
  • References

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.