Policy Bulletins
The Policy Bulletins listed below represent our catalogue of medical and claim payment policies. If you are looking for a specific type of policy, choose a category from the menu on the right. You may also use the search function in the top menu to search for policies by word or phrase.
 
   


Policy #
Policy Bulletin Title
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12.00.01f
Acupuncture (AmeriHealth)
12.00.01f
Attachment A (ICD-10 CM Codes Eligible to be Reported for Acupuncture) to 12.00.01f Acupuncture (AmeriHealth)
12.04.04a
Acute Care Facility Inpatient Transfers
12.04.03c
Air Ambulance Services
12.00.03g
Complementary and Integrative Health Services
12.01.03
Cosmetic Procedures
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12.01.01aw
Experimental/Investigational Services
12.01.01aw
Attachment A (Experimental/Investigational Services Represented by a Specific Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Code.) to 12.01.01aw Experimental/Investigational Services
12.01.01aw
Attachment B (Experimental/Investigational Services without a Specific Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Code.) to 12.01.01aw Experimental/Investigational Services
12.01.01aw
Attachment C (Experimental/Investigational services with a specific Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Code, that are reported for other services.) to 12.01.01aw Experimental/Investigational Services
12.04.02i
Ground Ambulance Services (Emergency and Nonemergency) (AmeriHealth)
12.01.02a
Medical Necessity
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12.05.01i
Outpatient Diabetes Education and Self-Management Training
12.05.01i
Attachment A (ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E08.00- E10.3491)) to 12.05.01i Outpatient Diabetes Education and Self-Management Training
12.05.01i
Attachment B (ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E10.3492- E13.37X2), Continued) to 12.05.01i Outpatient Diabetes Education and Self-Management Training
12.05.01i
Attachment C (ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E13.37X3- P70.2), Continued) to 12.05.01i Outpatient Diabetes Education and Self-Management Training