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.
00.10.42d, Telemedicine and Telehealth Services (Amerihealth New Jersey)
Notification: 01/15/2020 | Effective: 04/15/2020 | Posted: 01/15/2020
Type of policy change: Medical Coding

00.10.39l, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Notification: 01/15/2020 | Effective: 04/15/2020 | Posted: 01/15/2020
Type of policy change: Medical Coding

00.01.69, Consultation Services
Notification: 01/15/2020 | Effective: 04/15/2020 | Posted: 01/15/2020
Type of policy change: This is a new policy.

00.01.14r, Reporting and Documentation Requirements for Anesthesia Services
Notification: 01/22/2020 | Effective: 04/21/2020 | Posted: 01/22/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


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.
08.00.74m, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 01/02/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.04v, Immunizations
Effective: 01/01/2020 | Posted: 01/02/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.00.82k, Ustekinumab (Stelara®)
Effective: 01/06/2020 | Posted: 01/06/2020
Type of policy change: 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: 01/13/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

10.00.02c, Day Rehabilitation
Notification: 12/13/2019 | Effective: 01/13/2020 | Posted: 01/13/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

03.00.33a, Modifier 53 Discontinued Procedure
Effective: 01/13/2020 | Posted: 01/13/2020
Type of policy change: General Description, Guidelines, or Informational Update

03.00.32a, Modifier 52 Reduced Services
Effective: 01/13/2020 | Posted: 01/13/2020
Type of policy change: General Description, Guidelines, or Informational Update

08.00.88f, Ofatumumab (Arzerra®)
Effective: 01/20/2020 | Posted: 01/21/2020
Type of policy change: Medical Necessity Criteria

09.00.56j, Radiation Therapy Services (AmeriHealth)
Notification: 10/21/2019 | Effective: 01/21/2020 | Posted: 01/21/2020
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: 01/27/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

07.03.26a, Tumor Treating Fields
Notification: 12/27/2019 | Effective: 01/27/2020 | Posted: 01/27/2020
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.
11.03.02s, Bariatric Surgery
Reissue Effective: 01/09/2020 | Reissue Posted: 01/09/2020

04.00.05d, Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth
Reissue Effective: 01/09/2020 | Reissue Posted: 01/09/2020

07.02.22a, Esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)
Reissue Effective: 01/09/2020 | Reissue Posted: 01/09/2020

05.00.73c, Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
Reissue Effective: 01/29/2020 | Reissue Posted: 01/31/2020

05.00.74d, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Reissue Effective: 01/29/2020 | Reissue Posted: 01/31/2020


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.
11.04.01d, Islet Cell Transplantation
Effective: 01/01/2020 | Posted: 01/02/2020

06.02.47c, Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (AmeriHealth Administrators)
Effective: 01/01/2020 | Posted: 01/02/2020

07.03.25a, Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home
Effective: 01/01/2020 | Posted: 01/02/2020

11.01.07e, Cataract Surgery
Effective: 01/01/2020 | Posted: 01/02/2020

09.00.46y PA, High-Technology Radiology Services (AmeriHealth Pennsylvania)
Effective: 01/01/2020 | Posted: 01/02/2020

09.00.46y NJ, High-Technology Radiology Services (AmeriHealth New Jersey)
Effective: 01/01/2020 | Posted: 01/02/2020

07.02.09g, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Effective: 01/01/2020 | Posted: 01/03/2020

11.01.02o, Cochlear Implant
Effective: 01/01/2020 | Posted: 01/03/2020

07.07.09g, Stem-Cell Therapy for Orthopedic Applications and Autologous Platelet-Derived Growth Factors (PDGFs)/Platelet-Rich Plasmas (PRPs) for Acute or Chronic Wound Healing and Other Miscellaneous Conditions
Effective: 01/01/2020 | Posted: 01/03/2020

11.14.19n, Artificial Intervertebral Disc Insertion
Effective: 01/01/2020 | Posted: 01/03/2020

11.08.15x, Reconstructive Breast Surgery
Effective: 01/01/2020 | Posted: 01/03/2020

07.10.06h, Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation
Effective: 01/01/2020 | Posted: 01/03/2020

11.14.29e, Spinal Discectomy
Effective: 01/01/2020 | Posted: 01/03/2020

00.01.59f, Care Management and Care Planning Services
Effective: 01/01/2020 | Posted: 01/06/2020

00.10.39k, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Effective: 01/01/2020 | Posted: 01/06/2020

00.03.03h, Outpatient Short-Term Rehabilitation Services Included in Capitation
Effective: 01/01/2020 | Posted: 01/06/2020

00.10.36q, Radiologic Guidance of a Procedure
Effective: 01/01/2020 | Posted: 01/06/2020

05.00.21u, Durable Medical Equipment (DME) and Consumable Medical Supplies
Effective: 01/01/2020 | Posted: 01/06/2020

00.10.18k, Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
Effective: 01/01/2020 | Posted: 01/07/2020

00.10.11l, Modifier 62: Two Surgeons
Effective: 01/01/2020 | Posted: 01/07/2020

03.00.05j, Modifier 50: Bilateral Procedure
Effective: 01/01/2020 | Posted: 01/07/2020

03.00.06q, Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
Effective: 01/01/2020 | Posted: 01/07/2020

11.00.10v, Multiple Surgical Reduction Guidelines (AmeriHealth)
Effective: 01/01/2020 | Posted: 01/22/2020

00.01.25av, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 01/01/2020 | Posted: 01/27/2020


Archived Policies
AmeriHealth has determined that it is no longer necessary for the following commercial policy to remain active.
01.00.08c, Preoperative Consultations Performed by Providers in Anesthesia Specialties
Notification: 01/03/2020 (Revised: 01/15/2020) | Archive Effective: 04/15/2020 | Posted: 01/03/2020

01.00.02b, Anesthesia Services for a Cancelled or Discontinued Procedure
Notification: 01/22/2020 | Archive Effective: 04/21/2020 | Posted: 01/22/2020