Site Activity
This page provides a monthly listing of publication activity on the Medical Policy Portal including Policy Notifications, New Policies, Updated Policies, Coding Updates, Reissued Policies, and Archived Policies. To view publication activity from prior months, select Past Site Activity.

Past Site Activity

 
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Notifications
The following AmeriHealth commercial policies have been posted prior to their effective date.
00.06.02p, Preventive Care Services
Notification: 10/01/2015 | Effective: 01/01/2016 | Posted: 10/01/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

09.00.56b, Radiation Therapy Services
Notification: 10/01/2015 | Effective: 01/01/2016 | Posted: 10/01/2015
Type of policy change: General Description, Guidelines, or Informational Update

11.14.27, Spinal Fusion
Notification: 10/02/2015 | Effective: 01/01/2016 | Posted: 10/02/2015
Type of policy change: This is a new policy.

11.14.29, Spinal Discectomy
Notification: 10/02/2015 | Effective: 01/01/2016 | Posted: 10/02/2015
Type of policy change: This is a new policy.

11.14.28, Spinal Laminectomy
Notification: 10/02/2015, revised 11/24/2015 | Effective: 01/01/2016 | Posted: 10/02/2015
Type of policy change: This is a new policy.

11.06.06b, Magnetic Resonance Imaging (MRI)--Guided Focused Ultrasound Ablation
Notification: 10/07/2015 | Effective: 11/06/2015 | Posted: 10/07/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.73g, Bortezomib (Velcade®)
Notification: 10/07/2015 | Effective: 01/05/2016 | Posted: 10/07/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.04l, Immunizations
Notification: 10/16/2015 | Effective: 11/16/2015 | Posted: 10/16/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.02.26, Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Notification: 10/28/2015 | Effective: 11/27/2015 | Posted: 10/28/2015
Type of policy change: This is a new policy.

08.00.88c, Ofatumumab (Arzerra™)
Notification: 10/30/2015 | Effective: 11/30/2015 | Posted: 10/30/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


New Policies
The following commercial policies have been newly developed to communicate coverage and/or reimbursement positions, reporting requirements, and other processes and procedures for doing business with AmeriHealth.
05.00.77, Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia
Notification: 09/02/2015 | Effective: 10/01/2015 | Posted: 10/01/2015
Type of policy change: This is a new policy.

06.02.49, VeriStrat® Testing for Targeted Therapy in Non-Small-Cell Lung Cancer
Effective: 10/02/2015 | Posted: 10/02/2015
Type of policy change: This is a new policy.

06.02.47, Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA
Notification: 09/22/2015 | Effective: 10/21/2015 | Posted: 10/21/2015
Type of policy change: This is a new policy.

00.03.09a, X-rays Associated with Fractures in the Office Setting
Notification: 04/28/2011 | Effective: 10/01/2015 | Posted: 10/30/2015
Type of policy change: This is a new policy.


Updated Policies
The following commercial policies have been reviewed and updated to communicate current coverage and/or reimbursement positions, reporting requirements, and other procedures for doing business with AmeriHealth.
08.00.85e, Tocilizumab (Actemra®) for Intravenous Infusion
Notification: 07/01/2015 | Effective: 10/01/2015 | Posted: 10/01/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

12.01.01ad, Experimental/Investigational Services
Notification: 07/01/2015 | Effective: 10/01/2015 | Posted: 10/01/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

06.02.32b, Multigene Expression Assays for Predicting Recurrence in Colon Cancer
Effective: 10/02/2015 | Posted: 10/02/2015
Type of policy change: General Description, Guidelines, or Informational Update

11.14.10m, Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty
Effective: 10/02/2015 | Posted: 10/02/2015
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

07.05.06f, Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Effective: 10/02/2015 | Posted: 10/02/2015
Type of policy change: General Description, Guidelines, or Informational Update

07.00.20f, Routine Costs Associated with Qualifying Clinical Trials
Effective: 10/02/2015 | Posted: 10/02/2015
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.00.13e, Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Effective: 10/02/2015 | Posted: 10/02/2015
Type of policy change: General Description, Guidelines, or Informational Update

11.02.13f, Transcoronary Ablation of Septal Hypertrophy (TASH)
Effective: 10/02/2015 | Posted: 10/02/2015
Type of policy change: General Description, Guidelines, or Informational Update

07.05.07c, Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
Effective: 10/02/2015 | Posted: 10/02/2015
Type of policy change: General Description, Guidelines, or Informational Update

05.00.09h, Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System
Effective: 10/07/2015 | Posted: 10/07/2015
Type of policy change: Medical Necessity Criteria

07.11.02e, Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders
Effective: 10/07/2015 | Posted: 10/07/2015
Type of policy change: General Description, Guidelines, or Informational Update

08.00.33k, Trastuzumab (Herceptin®)
Effective: 10/07/2015 | Posted: 10/07/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.03.04j, Apheresis Therapy
Effective: 10/07/2015 | Posted: 10/07/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

08.01.07d, Pertuzumab (Perjeta®)
Effective: 10/07/2015 | Posted: 10/07/2015
Type of policy change: Medical Necessity Criteria; Medical Coding

11.11.06g, Saturation Needle Biopsy of the Prostate
Effective: 10/07/2015 | Posted: 10/07/2015
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

00.10.03i, Criteria for Reimbursement of Emergency Room Services
Effective: 10/01/2015 | Posted: 10/16/2015

09.00.48e, Radioembolization for Primary and Metastatic Tumors of the Liver (AmeriHealth New Jersey and AmeriHealth Administrators)
Effective: 10/19/2015 | Posted: 10/19/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.55f, Omalizumab (Xolair®)
Effective: 10/21/2015 | Posted: 10/21/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.05c, Carfilzomib (Kyprolis™)
Effective: 10/21/2015 | Posted: 10/21/2015
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.02.11f, Transcatheter Closure of Cardiac Septal Defects
Effective: 10/21/2015 | Posted: 10/21/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.03.07m, Evaluation and Management of Autism Spectrum Disorders (ASD)
Effective: 10/21/2015 | Posted: 10/21/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.14.19i, Artificial Intervertebral Disc Insertion
Notification: 09/23/2015 | Effective: 10/23/2015 | Posted: 10/23/2015
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
00.01.44e, Never Events and Preventable Adverse Events
Reissue Effective: 10/01/2015 | Reissue Posted: 10/02/2015

11.02.12f, Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery
Reissue Effective: 10/02/2015 | Reissue Posted: 10/02/2015

11.14.14e, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
Reissue Effective: 10/02/2015 | Reissue Posted: 10/02/2015

08.00.22l, Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
Reissue Effective: 10/02/2015 | Reissue Posted: 10/02/2015

08.01.11c, Ado-Trastuzumab Emtansine (Kadcyla®)
Reissue Effective: 09/30/2015 | Reissue Posted: 10/02/2015

11.02.19c, Total Artificial Hearts (TAHs)
Reissue Effective: 10/02/2015 | Reissue Posted: 10/02/2015

07.02.05i, External Counterpulsation (ECP)
Reissue Effective: 10/02/2015 | Reissue Posted: 10/02/2015

11.08.06g, Abdominoplasty and/or Panniculectomy
Reissue Effective: 09/30/2015 | Reissue Posted: 10/02/2015

11.03.01d, Repair of Cleft Lip, Cleft Nose, and/or Cleft Palate
Reissue Effective: 09/30/2015 | Reissue Posted: 10/02/2015

11.03.11l, Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Reissue Effective: 09/30/2015 | Reissue Posted: 10/02/2015

05.00.11e, Therapeutic Shoes and Orthopedic Shoes
Reissue Effective: 09/30/2015 | Reissue Posted: 10/02/2015

12.04.03b, Air or Sea Ambulance Transport Services
Reissue Effective: 10/14/2015 | Reissue Posted: 10/15/2015

12.04.02f, Nonemergency Ambulance Transport Services
Reissue Effective: 10/14/2015 | Reissue Posted: 10/15/2015

08.01.03c, Belatacept (Nulojix®)
Reissue Effective: 10/14/2015 | Reissue Posted: 10/15/2015

08.00.91c, Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP™, Glassia™, Zemaira™)
Reissue Effective: 10/14/2015 | Reissue Posted: 10/19/2015

05.00.59h, Lower Limb Prostheses
Reissue Effective: 10/14/2015 | Reissue Posted: 10/19/2015

05.00.44g, Repair and Replacement of Durable Medical Equipment (DME)
Reissue Effective: 10/15/2015 | Reissue Posted: 10/19/2015

08.00.86a, Ecallantide (Kalbitor®)
Reissue Effective: 10/14/2015 | Reissue Posted: 10/19/2015

11.05.07c, Surgical Correction of Strabismus
Reissue Effective: 10/14/2015 | Reissue Posted: 10/19/2015

08.01.09c, Omacetaxine mepesuccinate (Synribo®)
Reissue Effective: 10/14/2015 | Reissue Posted: 10/15/2015

08.00.93c, C1 Esterase Inhibitors: Cinryze®, Berinert®, and Ruconest®
Reissue Effective: 10/28/2015 | Reissue Posted: 10/29/2015


Coding Update
The following commercial policies have been reviewed and updated to add new and revised medical codes (e.g., ICD-9 and ICD-10 diagnosis codes; CPT® and HCPCS codes; revenue codes) and/or remove terminated medical codes.
07.07.07d, Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
Effective: 10/01/2015 | Posted: 10/01/2015

05.00.74a, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Effective: 10/01/2015 | Posted: 10/01/2015

07.13.07f, Corneal Pachymetry Using Ultrasound
Effective: 10/01/2015 | Posted: 10/01/2015

08.01.22a, Alemtuzumab (Lemtrada™)
Effective: 10/01/2015 | Posted: 10/01/2015

11.15.01o, Spinal Cord Stimulation (Dorsal Column Stimulation)
Effective: 10/01/2015 | Posted: 10/01/2015

11.15.09f, Denervation of the Spinal Nerves for Chronic Facet Pain
Effective: 10/01/2015 | Posted: 10/01/2015

10.02.02f, Chiropractic Spinal and Extraspinal Manipulation Therapy
Effective: 10/01/2015 | Posted: 10/01/2015

03.00.07q, Modifier 51: Multiple Procedures
Effective: 07/01/2015 | Posted: 10/14/2015

00.03.10a, Obstetrical Ultrasounds for Members enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) product
Effective: 10/01/2015 | Posted: 10/16/2015

00.01.25ab, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 10/01/2015 | Posted: 10/16/2015

00.03.06a, Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 10/01/2015 | Posted: 10/16/2015


Archived Policies
AmeriHealth has determined that it is no longer necessary for the following commercial policy to remain active.
05.00.63b, Home Use of Interferential and Sequential Stimulation Devices
Notification: 10/07/2015 | Archive Effective: 11/06/2015 | Posted: 10/07/2015

08.00.47f, Nesiritide (Natrecor®)
Notification: 09/09/2015 | Archive Effective: 10/09/2015 | Posted: 10/09/2015