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.
11.02.10n, Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Notification: 10/01/2019 | Effective: 12/30/2019 | Posted: 10/01/2019
Type of policy change: General Description, Guidelines, or Informational Update

11.14.07u, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 10/03/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

08.00.74m, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 10/03/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.25l, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 10/03/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

12.04.02i, Ground Ambulance Services (Emergency and Nonemergency) (AmeriHealth)
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 10/03/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.02e, Pegloticase (Krystexxa®)
Notification: 10/15/2019 | Effective: 01/13/2020 | Posted: 10/15/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

09.00.56j, Radiation Therapy Services (AmeriHealth)
Notification: 10/21/2019 | Effective: 01/21/2020 | Posted: 10/21/2019
Type of policy change: General Description, Guidelines, or Informational Update

12.01.01au, Experimental/Investigational Services
Notification: 10/29/2019 | Effective: 01/27/2020 | Posted: 10/29/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding


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.
07.13.01h, Orthoptic/Pleoptic Training
Effective: 10/07/2019 | Posted: 10/07/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

00.09.01f, Direct Access to Obstetrics/Gynecology (OB/GYN) Services
Effective: 10/07/2019 | Posted: 10/07/2019
Type of policy change: General Description, Guidelines, or Informational Update

12.01.01at, Experimental/Investigational Services
Effective: 10/01/2019 | Posted: 10/11/2019
Type of policy change: Medical Coding

08.00.64g, Natalizumab (Tysabri®)
Effective: 10/21/2019 | Posted: 10/21/2019
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.78ad, Self-Administered Drugs
Effective: 10/21/2019 | Posted: 10/21/2019
Type of policy change: Medical Coding

08.00.92aa, Coagulation Factors
Effective: 10/21/2019 | Posted: 10/21/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.13v, Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Effective: 10/21/2019 | Posted: 10/21/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.02.09f, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Effective: 10/21/2019 | Posted: 10/22/2019
Type of policy change: Medical Necessity Criteria


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
06.02.24j, Preimplantation Genetic Testing (AmeriHealth Administrators)
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

06.02.10q, Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (AmeriHealth Administrators)
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

06.02.27l, Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators)
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

00.01.48c, Marijuana for Medical Use
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

06.02.30e, Pharmacogenetic Testing to Determine Drug Sensitivity (AmeriHealth Administrators)
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

07.00.01h, Biofeedback Therapy
Reissue Effective: 10/09/2019 | Reissue Posted: 10/11/2019

08.01.53b, Moxetumomab Pasudotox-tdfk (Lumoxiti™)
Reissue Effective: 10/11/2019 | Reissue Posted: 10/11/2019

09.00.31d, Low Osmolar Contrast Agents
Reissue Effective: 10/09/2019 | Reissue Posted: 10/11/2019

07.03.25, Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home
Reissue Effective: 10/11/2019 | Reissue Posted: 10/11/2019

08.00.49e, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Reissue Effective: 10/09/2019 | Reissue Posted: 10/11/2019

09.00.13c, High Osmolar Contrast Agents
Reissue Effective: 10/09/2019 | Reissue Posted: 10/11/2019

07.07.05b, Photography, Including Documentation and Record-Keeping Photography, Whole Body Integumentary Photography, Dermoscopy, and Dermatoscopy
Reissue Effective: 10/11/2019 | Reissue Posted: 10/11/2019

06.02.32d, Multigene Expression Assays for Predicting Recurrence in Colon Cancer (AmeriHealth Administrators)
Reissue Effective: 10/11/2019 | Reissue Posted: 10/11/2019

11.16.01h, Septoplasty, Rhinoplasty, and Septorhinoplasty
Reissue Effective: 10/23/2019 | Reissue Posted: 10/23/2019

08.00.18m, Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk
Reissue Effective: 10/23/2019 | Reissue Posted: 10/23/2019


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.
00.06.02aa, Preventive Care Services (AmeriHealth)
Effective: 10/01/2019 | Posted: 10/01/2019

11.08.20u, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Effective: 10/01/2019 | Posted: 10/02/2019

05.00.74d, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Effective: 10/01/2019 | Posted: 10/02/2019

05.00.30m, Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices (AmeriHealth Adminstrators)
Effective: 10/01/2019 | Posted: 10/02/2019

11.08.15w, Reconstructive Breast Surgery
Effective: 10/01/2019 | Posted: 10/02/2019

05.00.26h, Home Prothrombin Time Monitoring
Effective: 10/01/2019 | Posted: 10/02/2019

07.03.24a, Laboratory-Based Vestibular Function Testing
Effective: 10/01/2019 | Posted: 10/02/2019

07.03.09p, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Effective: 10/01/2019 | Posted: 10/02/2019

07.02.21d, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Effective: 10/01/2019 | Posted: 10/02/2019

07.03.18o, Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Effective: 10/01/2019 | Posted: 10/02/2019

07.03.21k, Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
Effective: 10/01/2019 | Posted: 10/02/2019

08.00.49e, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Effective: 10/01/2019 | Posted: 10/02/2019

07.07.07g, Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
Effective: 10/01/2019 | Posted: 10/02/2019

05.00.60h, Pressure-Reducing Support Surfaces
Effective: 10/01/2019 | Posted: 10/02/2019

07.07.01o, Routine Foot Care for Certain Medical Conditions
Effective: 10/01/2019 | Posted: 10/02/2019

08.00.33n, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Effective: 10/01/2019 | Posted: 10/02/2019

08.01.50b, Patisiran (Onpattro™)
Effective: 10/01/2019 | Posted: 10/03/2019

08.00.78ac, Self-Administered Drugs
Effective: 10/01/2019 | Posted: 10/03/2019

08.00.94m, Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity™)
Effective: 10/01/2019 | Posted: 10/03/2019

08.01.26b, Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., pegademase bovine [Adagen®], elapegademase-lvlr [Revcovi™])
Effective: 10/01/2019 | Posted: 10/03/2019

08.00.66m, Bevacizumab (Avastin®) and Related Biosimilars
Effective: 10/01/2019 | Posted: 10/03/2019

08.01.55b, Tagraxofusp-erzs (Elzonris™)
Effective: 10/01/2019 | Posted: 10/03/2019

11.02.01s, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Effective: 10/01/2019 | Posted: 10/03/2019

08.01.54b, Emapalumab-lzsg (Gamifant®)
Effective: 10/01/2019 | Posted: 10/03/2019

08.01.52a, Mogamulizumab-kpkc (Poteligeo®)
Effective: 10/01/2019 | Posted: 10/03/2019

08.00.84f, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)
Effective: 10/01/2019 | Posted: 10/03/2019

11.16.08c, Implantable Steroid-Eluting Sinus Stents
Effective: 10/01/2019 | Posted: 10/03/2019

11.02.06m, Catheter Ablation of Cardiac Arrhythmias
Effective: 10/01/2019 | Posted: 10/03/2019

11.08.17i, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Effective: 10/01/2019 | Posted: 10/03/2019

08.01.53b, Moxetumomab Pasudotox-tdfk (Lumoxiti™)
Effective: 10/01/2019 | Posted: 10/03/2019

11.08.19n, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Effective: 10/01/2019 | Posted: 10/03/2019

11.02.26b, Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Effective: 10/01/2019 | Posted: 10/03/2019

06.02.52n, eviCore Lab Management Program (AmeriHealth)
Effective: 10/01/2019 | Posted: 10/21/2019

11.03.02s, Bariatric Surgery
Effective: 10/01/2019 | Posted: 10/21/2019

11.15.01v, Spinal Cord and Dorsal Root Ganglion Stimulation
Effective: 10/01/2019 | Posted: 10/21/2019

11.14.29d, Spinal Discectomy
Effective: 10/01/2019 | Posted: 10/21/2019

07.02.22a, Esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)
Effective: 10/01/2019 | Posted: 10/21/2019

11.14.19m, Artificial Intervertebral Disc Insertion
Effective: 10/01/2019 | Posted: 10/21/2019

06.02.44k, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Effective: 10/01/2019 | Posted: 10/21/2019

06.02.35v, Genetic Testing (AmeriHealth Administrators)
Effective: 10/01/2019 | Posted: 10/21/2019

00.01.25au, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 10/01/2019 | Posted: 10/22/2019

00.03.06f, 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: 10/01/2019 | Posted: 10/22/2019

00.03.07x, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 10/01/2019 | Posted: 10/24/2019


Archived Policies
AmeriHealth has determined that it is no longer necessary for the following commercial policy to remain active.
04.00.03a, Dental Extractions Prior to Cardiac Surgery, Radiation Therapy, or Transplant Surgery
Notification: 10/14/2019 | Archive Effective: 11/18/2019 | Posted: 10/14/2019

00.10.16d, Physician/Nonphysician Standby Services
Notification: 10/25/2019 | Archive Effective: 01/01/2020 | Posted: 10/25/2019