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Payment Policy Updates

Date: 07/22/25

Ambetter Health of Delaware 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 bi-monthly basis, prior to updates, clinical policies are reviewed and approved by the National Marketplace Quality Improvement Committee (QIC).

This page reflects all clinical and policy changes. The full list of policies are on the Clinical and Payment Policies section under Provider Resources.

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

Policy Updates: Effective: September 20th, 2025

Clinical Policies With Changes

  • Air Ambulance CP.MP.175
  • Bariatric Surgery CP.MP.37
  • Behavioral Health Treatment Documentation Requirements HIM.CP.BH.500
  • Deep Transcranial Magnetic Stimulation for Treatment of Obsessive Compulsive Disorder CP.BH.201
  • Gastric Electrical Stimulation CP.MP.40
  • Heart-Lung Transplant CP.MP.132
  • Intensity-Modulated Radiotherapy CP.MP.69
  • Long Term Care Placement CP.MP.71
  • Lung Transplantation CP.MP.57
  • Nerve Blocks and Neurolysis for Pain Management CP.MP.170
  • NICU Apnea Bradycardia Guidelines CP.MP.82
  • NICU Discharge Guidelines CP.MP.81
  • Outpatient Cardiac Rehabilitation CP.MP.176
  • Pancreas Transplantation CP.MP.102
  • Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention CP.MP.147
  • Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins CP.MP.146
  • Skin and Soft Tissue Substitutes for Chronic Wounds with Changes CP.MP.185
  • Tandem Transplant CP.MP.162
  • Total Parenteral Nutrition and Intradialytic Parenteral Nutrition CP.MP.163
  • Transcranial Magnetic Stimulation for Treatment of Major Depression CP.BH.200
  • Transplant Service Documentation Requirements CP.MP.247 

Retired Policies

  • Functional MRI CP.MP.43
  • Fertility Preservation CP.MP.130
  • Concert Genetic Testing: Hereditary Cancer Susceptibility CG 2025.1
  • Assisted Reproductive Technology CP.MP.55
  • Articular Cartilage Defect Repair CP.MP.26