Updates to Medical Necessity Guidelines

April 1, 2026

Refer to the following chart to review changes and updates to CarePartners of Connecticut’s Medical Necessity Guidelines, which detail coverage and prior authorization criteria.

Updates to Medical Necessity Guidelines (MNG)
MNG Title	Effective Date	Summary
CarePartners of Connecticut Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines	6/1/2026	Prior authorization will be required for the following codes/services: Incontinence Devices 53445 Sacral Nerve Stimulation for Urinary Incontinence 64561 64581 Sacral Nerve Stimulation for Fecal Incontinence 64561 64581 Osteogenesis Stimulators E0747 Septoplasty 30520 FoundationOne® Liquid CDx 0239U Lower Limb Prostheses L5827 L5828 L5856 L5857 L5858 L5980 L5981 L5987 L5973
Upper Gastrointestinal Endoscopy (Esophagogastroduodenoscopy, EGD)	6/1/2026	MNG updated to specify that CPT code 43249 (for esophageal dilation procedures using an endoscope) will be covered with prior authorization only when submitted with an appropriate ICD-10 diagnosis code.