News

Payment Policy Updates: Effective May 19, 2026

Date: 03/20/26

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: May 19th, 2026

CLINICAL POLICIES WITH CHANGES

Allogeneic Hemapoietic Cell Transplants for SCA and Beta Thalassemia CP.MP.108
Applied Behavior Analysis CP.MP.104
Applied Behavioral Analysis Documentation Requirements CP.BH.105
Bariatric Surgery CP.MP.37
Behavioral Health Clinical Policy Committee BH.CPC.01
Biofeedback CP.MP.168
Clinical Policy Web Posting CP.CPC.02
Concert Genetic Testing Oncology: Algorithmic Assays
Concert Genetic Testing Oncology: Cancer Screening and Surveillance V2.2025
Concert Genetic Testing Oncology: Hematologic Malignancy V2.2025
Concert Genetic Testing Oncology: Solid Tumor Molecular Diagnostics V2.2025
Concert Genetic Testing: Cardiovascular V2.2025
Concert Genetic Testing: Gastroenterology V2.2025
Concert Genetic Testing: Hereditary Cancer V2.2025
Concert Genetic Testing: Identity and Forensics V2.2025
Concert Genetic Testing: Multisystem Genetic Conditions V2.2025
Concert Genetic Testing: Nephrology V2.2025
Concert Genetic Testing: Neurology V2.2025
Concert Genetic Testing: Nutrition and Metabolism V2.2025
Concert Genetic Testing: Preimplantation Genetic Testing V2.2025
Concert Genetic Testing: Prenatal Screening V2.2025
Concert Genetic Testing: Toxicology and Pharmacogenetics Version A V2.2025
Concert Genetic Testing: Transplant V2.2025
Cosmetic and Reproductive Procedures CP.MP.31
DME CP.MP.107
Experimental Technologies CP.MP.36
Hyperhidrosis Treatments CP.MP.62
Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea CP.MP.180
IV Moderate and IV Deep Sedation and Gen Anesth for Dental Procedures CP.MP.61
Medical Necessity Criteria CP.CPC.05
Obstetrical Home Care Programs CP.MP.91
Orthognathic Surgery CP.MP.202
Outpatient Oxygen Use CP.MP.190
Panniculectomy CP.MP.109
Pediatric Heart Transplant CP.MP.138
Proton and Neutron Beam Therapies CP.MP.70
Radiation Therapy for Skin Cancer CP.MP.251
Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy CP.MP.174
Skin and Soft Tissue Substitutes for Diabetic Foot Ulcers and Venous Leg Ulcers CP.MP.185
Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation CP.MP.117
State Specific Clinical Policy Process CP.CPC.04

NEW CLINICAL POLICIES

Concert Genetic Testing: Identify and Forensics V2.2025
Concert and Genetic Testing: Nutrition and Metabolism V2.2025