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

 
Jul 2020  Jun 2020  May 2020  Apr 2020  Mar 2020  Feb 2020  Jan 2020  Dec 2019  Nov 2019  Oct 2019  Sep 2019  Aug 2019  Jul 2019  Jun 2019  May 2019  Apr 2019  Mar 2019  Feb 2019  Jan 2019  Dec 2018  Nov 2018  Oct 2018  Sep 2018  Aug 2018  Jul 2018  Jun 2018  May 2018  Apr 2018  Mar 2018  Feb 2018  Jan 2018  Dec 2017  Nov 2017  Oct 2017  Sep 2017  Aug 2017  Jul 2017  Jun 2017  May 2017  Apr 2017  Mar 2017  Feb 2017  Jan 2017  Dec 2016  Nov 2016  Oct 2016  Sep 2016  Aug 2016  Jul 2016  Jun 2016  May 2016  Apr 2016  Mar 2016  Feb 2016  Jan 2016  Dec 2015  Nov 2015  Oct 2015  Sep 2015  Aug 2015  Jul 2015  Jun 2015  

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.
11.06.05e, Endometrial Ablation
Effective: 01/06/2017 | Posted: 01/06/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

11.17.04q, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Notification: 11/30/2016 | Effective: 01/06/2017 | Posted: 01/06/2017

11.15.09i, Denervation of the Spinal Nerves for Chronic Pain
Effective: 01/06/2017 | Posted: 01/06/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.01g, Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Treatment
Effective: 01/11/2017 | Posted: 01/11/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

12.00.03d, Complementary and Integrative Health Services
Effective: 01/11/2017 | Posted: 01/11/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

00.01.47c, Inpatient Hospital Readmission
Notification: 12/15/2016 | Effective: 01/15/2017 | Posted: 01/13/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

11.14.19k, Artificial Intervertebral Disc Insertion
Effective: 01/13/2017 | Posted: 01/13/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.14.02l, Trigger Point Injections
Effective: 01/13/2017 | Posted: 01/13/2017
Type of policy change: Medical Coding

07.07.03j, Photodynamic Therapy (PDT) Using Levulan® Kerastick® (Aminolevulinic Acid HCl [ALA]) or Metvixia® (Methyl Aminolevulinate [MAL])
Effective: 01/18/2017 | Posted: 01/18/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.20e, Programmed Death Receptor-1 (PD-1) Antagonists (e.g., Keytruda®, Opdivo®) and Programmed Death-Ligand 1 (PD-L1) Antagonist (e.g., Tecentriq®)
Effective: 01/25/2017 | Posted: 01/25/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
02.01.02c, Private Duty Nursing
Reissue Effective: 01/04/2017 | Reissue Posted: 01/04/2017

01.00.09c, Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump
Reissue Effective: 01/18/2017 | Reissue Posted: 01/18/2017

11.16.06g, Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
Reissue Effective: 01/18/2017 | Reissue Posted: 01/18/2017


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.
05.00.62h, Injectable Dermal Fillers
Effective: 01/01/2017 | Posted: 01/03/2017

03.00.15m, Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period
Effective: 01/01/2017 | Posted: 01/06/2017

03.00.06m, Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure or Other Service
Effective: 01/01/2017 | Posted: 01/06/2017

00.01.52e, Always Bundled Procedure Codes
Effective: 01/01/2017 | Posted: 01/06/2017

09.00.32r, Diagnostic and Therapeutic Radiopharmaceutical Agents
Effective: 01/01/2017 | Posted: 01/06/2017

00.10.39g, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Effective: 01/01/2017 | Posted: 01/06/2017

00.03.03f, Outpatient Short-Term Rehabilitation Services Included in Capitation
Effective: 01/01/2017 | Posted: 01/06/2017

00.03.07o, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 01/01/2017 | Posted: 01/06/2017

03.00.28k, Modifier 79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Effective: 01/01/2017 | Posted: 01/06/2017

03.00.16m, Modifier 57: Decision for Surgery
Effective: 01/01/2017 | Posted: 01/06/2017

11.00.10u, Multiple Surgical Reduction Guidelines (AmeriHealth)
Effective: 01/01/2017 | Posted: 01/06/2017

00.03.02w, Diagnostic Radiology Services Included in Capitation
Effective: 01/01/2017 | Posted: 01/06/2017

00.01.49c, Reporting Requirements for Drugs and Biologics
Effective: 01/01/2017 | Posted: 01/06/2017