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Clinical Policy Updates - Effective 12/8/2025

Date: 10/07/25

Delaware First Health reviews all clinical and payment 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 quarterly basis, prior to updates, clinical policies are reviewed and approved by Delaware First Health’s Quality Improvement and Utilization Management Committee (QI/UMC).

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 Account Manager if you have any questions.

Policy Updates: Effective: Monday, December 8th, 2025

CLINICAL POLICIES WITH CHANGES

  • Allogeneic Hematopoietic Progenitor Cell Therapy CP.MP.249
  • Bone-Anchored Hearing Aid CP.MP.93         
  • Caudal or Interlaminar Epidural Steroid Injections CP.MP.164
  • Facet Joint Interventions CP.MP.171
  • Fecal Incontinence Treatments CP.MP.137   
  • Fetal Surgery in Utero for Prenatally Diagnosed Malformations CP.MP.129
  • NICU Discharge Guidelines CP.MP.81          
  • PT OT ST CP.MP.49  
  • Reduction Mammoplasty and Gynecomastia Surgery CP.MP.51     
  • Sacroiliac Joint Interventions for Pain Management CP.MP.166      
  • Skin and Soft Tissue Substitutes for Chronic Wounds CP.MP.185   
  • Selective Nerve Root Blocks and Transforaminal Epidural Steroid Injections CP.MP.165
  • Total Artificial Heart CP.MP.127         
  • Transplant Service Documentation Requirements CP.MP.247