Updates to Medical Necessity Guidelines

January 30, 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	2/1/2026	Prior authorization will only be required for microprocessor/complex components of upper limb prosthetics, and is no longer required for these standard prosthetic build codes.
Medicare Noncovered Investigational Services	2/1/2026	Removed CPT code 27278 from the policy, as we will now cover this code in alignment with CMS’s local coverage determination.
Non-Emergent Ambulance Transportation	2/1/2026	Prior authorization is no longer required for hospital-to-SNF transfers. We will continue to evaluate prior authorization requirements in the future, and will provide appropriate notice in the event that authorization is reinstated.