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Effective November 25, 2024: Clinical Policies

Date: 11/20/24

Superior HealthPlan has updated certain clinical policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on November 25, 2024, at 12:00AM.

Changes in these policies reflect preauthorization requirement amendments that are less burdensome to insureds, physicians, or health care providers.

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Stereotactic Body Radiation Therapy

(CP.MP.22)

Ambetter

Policy updates include:

  • Updated I.I. and II.H. from “inoperable spinal tumors causing compression or intractable pain” to “spinal tumors”
  • Removed example of trigeminal neuralgia from criteria II.J. as already stated in II.E

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

Prior to updates, Medical Clinical policies are reviewed and approved by the Utilization Management Committee.

For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.