PAYMENT POLICY UPDATES

Date: 03/17/26

Wellcare reviews all clinical policies at least annually. This review is done to ensure medical necessity review criteria is current and appropriate for members and the scope of the services. On a quarterly basis, prior to updates, clinical policies are reviewed and approved by the National Medicare Quality Improvement & Management Committee (QI/UMC).

All new polices and policies with updates may be found on our Medical Clinical Policy Updates page. The full list of policies may be found on the Medical Clinical Policies page.

Please reach out to your Provider Engagement Account Manager if you have any questions.

Policy Updates: Effective February 9, 2026

MEDICAL CLINICAL POLICIES WITH CHANGES

• Sacoiliac Joint Interventions for Pain Management MC.CP.MP.166
• Transplant Service Documentation Requirements MC.CP.MP.247
• Cosmetic and Reconstructive Procedures MC.CP.MP.31
• AHCT for Sickle Cell Anemia MC.CP.MP.108

NEW POLICIES

• Medical Necessity Criteria MC.CPC.05
• DME MC.CP.MP.107

RETIRED

• Implantable Wireless PAP Monitoring MC.CP.MP.150

Policy Updates: Effective April 20, 2026

MEDICAL CLINICAL POLICIES WITH CHANGES

• Outpatient Oxygen Use MC.CP.MP.190
• Skin and Soft Tissue Substitutes for Chronic Wounds MC.CP.MP.185
• Transplant Service Documentation Requirements MC.CP.MP.247
• Facility-based Sleep Studies for Obstructive Sleep Apnea MC.CP.MP.248
• Skin and Soft Tissue Substitutes for Diabetic Foot Ulcers Venous Leg Ulcers MC.CP.MP.185