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Mutual News April 2026 Newsletter
Medical Mutual of Ohio·Mutual News Newsletter
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Medical Mutual is implementing major billing changes effective May 1 and June 1, 2026, including new reimbursement policies for related services and replacement codes, updated timely filing requirements (180 days for corrected claims and non-clinical disputes), and numerous medical policy updates affecting specific procedures. Key changes include new prior authorization requirements for bariatric surgery code 43889 and removal of frequency limitations for bone density studies.
Action Required
By May 1, 2026: Update billing system with new reimbursement policies for related services/supplies (RP-202603) and replacement codes (RP-202604). Update Maximum Frequency Per Day billing to separate claim lines for excess units. By June 1, 2026: Implement new 180-day timely filing limits for corrected claims and non-clinical disputes in billing workflows. Add prior authorization requirement for CPT 43889 (bariatric surgery). Remove prior authorization requirements for bone density codes 76977, 77080, 77081, 77085, 77086, G0130. Update all affected medical policies and notify third-party billing vendors of these changes.