Medicare AdvantagePrior AuthHigh impact
Mutual News September 2026 Newsletter
Medical Mutual of Ohio·Psychiatry, Ophthalmology, Dermatology +10 more·Mutual News Newsletter
Effective date
Sep 16, 2026
We identified it
Aug 25, 2026
Summary
Medical Mutual released a September 2026 policy newsletter with multiple medical policy updates including 5 new policies (low-frequency ultrasound therapy, phrenic nerve stimulation, gastric electrical stimulation, drug-eluting sinus devices, and sleep studies), 3 archived/retired policies, and updates to existing policies affecting billing codes. Key code changes include additions to prior authorization lists for EMDR (archived), low-level laser therapy (CPT 1011T, 97037), peripheral nerve stimulation (HCPCS A4541, E0733 reinstated), and skin surveillance (CPT 1020T). Multiple Avalon laboratory billing codes (G-codes and M-codes) were updated. Administrative changes are effective 15 days from September 1, 2026; material changes effective 90 days; new prior authorizations effective 30 days.
Action Required
REQUIREMENTS: By September 16, 2026 (15 days from policy date): Billing team must review full medical policy language on Medmutual.com/Provider > Policies and Standards > Medical Policies for all archived, new, and updated policies. By September 16, 2026: Update billing software to reflect administrative (non-material) changes affecting skin surveillance (CPT 1020T), low-level laser therapy (CPT 1011T, 97037 for prior auth), and peripheral nerve stimulation (HCPCS A4541, E0733 reinstated). By October 1, 2026 (30 days from policy date): Implement new prior authorization requirements for: CPT 1011T and 97037 (low-level laser therapy); new policies for low-frequency ultrasound (CPT codes TBD on provider portal), phrenic nerve stimulation, gastric electrical stimulation, and drug-eluting sinus devices. By December 1, 2026 (90 days from policy date): Implement all material policy changes. Billing team must update Prior Authorization Lists (PAL) in billing system using CPT/HCPCS codes available at Medmutual.com/Provider under Prior Approval Resources. Update all Avalon laboratory billing codes (G2006, G2035, G2113, G2149, G2150, G2151, G2155, G2156, G2173, G2174, G2181, M2068, M2097, R2162) per updated policy. Remove EMDR billing guidance (202506 archived). Verify exclusionary implant codes (Nalu Neurostimulation System, Freedom PNS System, MoleMapCD, MoleMate) are marked as investigational/experimental (IE) in system. Failure to implement prior authorization requirements will result in claim denials.