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.
08.00.78x, Self-Administered Drugs
Notification: 10/03/2017 (Revised 12/05/2017) | Effective: 01/01/2018 | Posted: 10/03/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.01.41, Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
Notification: 10/03/2017 (Revised 11/02/2017, 11/07/2017, and 11/16/2017) | Effective: 01/01/2018 | Posted: 10/03/2017
Type of policy change: This is a new policy.

00.01.64, Consultation Codes (AmeriHealth New Jersey)
Notification: 10/03/2017 | Effective: 01/01/2018 | Posted: 10/03/2017
Type of policy change: This is a new policy.

11.02.27, Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound
Notification: 10/03/2017 | Effective: 01/02/2018 | Posted: 10/03/2017
Type of policy change: This is a new policy.

00.01.66, Musculoskeletal Services
Notification: 10/03/2017 (Revised 11/02/2017) | Effective: 01/02/2018 | Posted: 10/03/2017
Type of policy change: This is a new policy.

06.02.44e, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Notification: 10/13/2017 | Effective: 01/01/2018 | Posted: 10/13/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.42, Edaravone (Radicava™)
Notification: 10/18/2017 | Effective: 11/17/2017 | Posted: 10/18/2017
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.
07.00.01h, Biofeedback Therapy
Notification: 09/06/2017 | Effective: 10/06/2017 | Posted: 10/06/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.16.01h, Septoplasty, Rhinoplasty, and Septorhinoplasty
Notification: 07/12/2017 | Effective: 10/10/2017 | Posted: 10/10/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.00.50p, Rituximab (Rituxan®) infusion, and rituximab and hyaluronidase human (Rituxan Hycela™) for subcutaneous injection
Effective: 10/18/2017 | Posted: 10/18/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.11d, Ado-Trastuzumab Emtansine (Kadcyla®)
Effective: 10/18/2017 | Posted: 10/18/2017
Type of policy change: Medical Necessity Criteria

08.01.00e, Hydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies
Effective: 10/18/2017 | Posted: 10/18/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.22c, Alemtuzumab (Lemtrada™)
Effective: 10/18/2017 | Posted: 10/18/2017
Type of policy change: Medical Necessity Criteria

08.00.51i, Enzyme Replacement for the Treatment of Gaucher's Disease
Notification: 07/26/2017 | Effective: 10/24/2017 | Posted: 10/24/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

08.00.92s, Coagulation Factors
Notification: 09/29/2017 | Effective: 10/30/2017 | Posted: 10/30/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.74l, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (e.g., ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], aflibercept [Eylea®], and related biosimilars)
Notification: 09/29/2017 | Effective: 10/30/2017 | Posted: 10/30/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.78w, Self-Administered Drugs
Notification: 09/29/2017 | Effective: 10/30/2017 | Posted: 10/30/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
09.00.24c, Full-Body Computerized Tomography (CT) Scan Screening
Reissue Effective: 10/24/2017 | Reissue Posted: 10/24/2017


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.
06.02.10q, Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (AmeriHealth Administrators)
Effective: 10/01/2017 | Posted: 10/02/2017

06.02.35o, Genetic Testing (AmeriHealth Administrators)
Effective: 10/01/2017 | Posted: 10/02/2017

06.02.44d, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Effective: 10/01/2017 | Posted: 10/02/2017

07.13.11g, Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
Effective: 10/01/2017 | Posted: 10/02/2017

06.02.52g, eviCore Lab Management Program (AmeriHealth)
Effective: 10/01/2017 | Posted: 10/02/2017

06.02.51a, Testing Serum Vitamin D Levels
Effective: 10/01/2017 | Posted: 10/02/2017

08.00.73i, Bortezomib (Velcade®)
Effective: 10/01/2017 | Posted: 10/02/2017

00.01.25an, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 10/01/2017 | Posted: 10/02/2017

08.01.20g, Programmed Death Receptor-1 (PD-1) Antagonists (e.g., Keytruda®, Opdivo®) and Programmed Death-Ligand 1 (PD-L1) Antagonists (e.g., Tecentriq®, Bavencio®, Imfinzi™)
Effective: 10/01/2017 | Posted: 10/04/2017

00.03.10d, Obstetrical Ultrasounds for Members enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) product
Effective: 10/01/2017 | Posted: 10/09/2017


Archived Policies
AmeriHealth has determined that it is no longer necessary for the following commercial policy to remain active.
08.00.93e, C1 Esterase Inhibitors: Cinryze®, Berinert®, and Ruconest®
Notification: 10/03/2017 | Archive Effective: 01/01/2018 | Posted: 10/03/2017