New or Updated Policies - Effective August 1, 2026
Date: 07/01/26
MHS Health Wisconsin regularly adds new or provides updates to clinical and payment policies to ensure they are designed to comply with industry standards while delivering the best experiences and outcomes for our members.
You can view the details of these policies on their effective date by visiting Clinical and Payment Policies.
The following new policies or policy revisions are effective August 1, 2026.
| Policy ID | Policy Name | Description | Line(s) of Business |
| CP.MP.120 | Pediatric Liver Transplant | Annual review. Removed criteria under I.A. Removed “is” under previous I.B. Under previous I.B.4.c. added “radiological”. For previous I.B.5.j. removed “complications” and added “pediatric acute liver failure…”. For previous I.B.5.l. added “while receiving conventional…”. For previous I.B.5.i. removed “conventional therapy”. For previous I.B.5.iv. removed “despite conventional…”. Under new I.B.14. added “irreversible” and “not attributable to the underlying organ disease…”. References reviewed and updated. | Medicaid; Medicare |
| CP.MP.129 | Fetal Surgery in Utero for Prenatally Diagnosed Malformations | Annual review. Annual review. Under I.C. added “with treatment including”. Added additional criteria I.C.1.a. Hydropic fetus or at risk of developing hydrops, I.C.1.b. Failure of one round of maternal antenatal corticosteroid, unless contraindicated. Added note under criteria I.D. to include “Note: May include fetal pleural aspiration…”. Added additional criteria I.H.2. Under I.G.6.a added “fetal”. Singleton pregnancy. Background updated with no impact on criteria. Added CPT 59074. References reviewed and updated. Reviewed by internal and external specialist. | Medicaid; Medicare |
| CP.MP.164 | Caudal or Interlaminar Epidural Steroid Injections | Annual review. Removed informational note about discontinuing anti-platelet therapy. Updated Criteria I.D.1 from two months to three months regarding relief and functional movement. Removed Criteria I.D.2. regarding length of time since last ESI. Coding and descriptions reviewed. References reviewed and updated. | Medicaid; Medicare |
| CP.MP.49 | Physical, Occupational, and Speech Therapy Services | Annual review. Added Note under Criteria I.B.8. stating, “If a member/enrollee is exposed to more than one language, evaluation of speech and language abilities must be culturally and linguistically appropriate…” Background updated to support added Note after Criteria I.B.8. References reviewed and updated. Reviewed by internal specialist and external specialist. | Medicaid; Medicare |
| CP.MP.186 | Burn Surgery | Description revised to exclude skin substitutes. Updated “Note” section. Moved all of criteria section II to CP.MP.185 Skin and Soft Tissue Substitutes. Removed CPT codes 15271 to 15278 from CPT code table. Removed HCPCS code table. Removed skin graft information from the background. | Medicaid; Medicare |
View all Clinical and Payment Policies.
Thank you for being a valued partner in caring for the health and well-being of our members. If you have any questions about the policies listed above or any our Clinical & Payment Policies, please contact your Provider Relations representative or call the Provider Inquiry Line at 1-800-222-9831. If you are unsure who is your representative, please email us at WI_Provider_Relations@mhswi.com.