Payment Policy Updates

Date: 12/18/25

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 Account Manager if you have any questions.

Policy Updates Effective: February 16^th, 2026

CLINICAL POLICIES WITH CHANGES

• Electric Tumor Treating Fields (Optune) CP.MP.145
• Facility-based Sleep Studies for Obstructive Sleep Apnea CP.MP.248
• Mechanical Stretching Devices for Joint Stiffness and Contracture CP.MP.144
• Pediatric Oral Function Therapy CP.MP.188
• Skin and Soft Tissue Substitutes for Chronic Wounds CP.MP.185
• Transplant Service Documentation Requirements CP.MP.247

PAYMENT POLICIES WITH CHANGES

• Allergy Testing and Therapy PI CP.MP.100
• Digital EEG Spike Analysis PI CP.MP.105
• Endometrial Ablation PI CP.MP.106

We always want to hear from you! If you notice anything missing or have suggestions for additional materials that would support your work, please let us know by submitting feedback through our Provider Feedback Form.

Need Help or Have Questions? Reach out to us through the following channels:

1. Provider Services – 1-833-919-3214, Monday – Friday 8am – 5pm EST
2. General inquiries, email - DE_ProviderEngagement@DelawareFirstHealth.com
3. Contact your dedicated Provider Engagement Account Manager