CLINICAL AND PAYMENT POLICY UPDATES

Date: 08/01/25

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 Clinical and Payment Policies page. 

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

 Policy Updates: Effective: November 1, 2025

CLINICAL AND PAYMENT POLICIES WITH CHANGES

• Transplant Service Documentation Requirements MC.CP.MP.247
• Skin and Soft Tissue Substitutes for Chronic Wounds MC.CP.MP.185
• Allogeneic Hematopoietic Proginator Cell Therapy MC.CP.MP.249

RETIRED

• Polymerase Chain Reaction Respiratory Viral Panel Testing MC.CP.MP.181
• GI Pathogen Nucleic Detection Panel Testing MC.CP.MP.209