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.
00.01.66a, Musculoskeletal Services
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.03.05u, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.52h, eviCore Lab Management Program
Notification: 12/01/2017 | Effective: 01/02/2018 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.57m, Treatments for Complex Regional Pain Syndrome (CRPS)
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.00.09f, Solid Organ Transplantation and Procurement Cost of Organs and Tissues
Notification: 12/01/2017 | Effective: 01/01/2018 | Posted: 12/01/2017
Type of policy change: General Description, Guidelines, or Informational Update

11.15.09j, Denervation of the Spinal Nerves for Chronic Pain
Notification: 12/01/2017 (revised 02/27/2018) | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: General Description, Guidelines, or Informational Update

11.15.23f, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
Notification: 12/01/2017 (revised 02/27/2018) | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.72g, Alglucosidase alfa (e.g., Lumizyme®)
Notification: 12/22/2017 | Effective: 01/22/2018 | Posted: 12/22/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.08.23i, Mohs' Micrographic Surgery
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.02.01p, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.15p, Nebulizers and Inhalation Solutions
Notification: 12/27/2017 | Effective: 01/26/2018 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

07.13.11h, Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
Notification: 12/27/2017 | Effective: 03/28/2018 | Posted: 12/27/2017
Type of policy change: General Description, Guidelines, or Informational Update

07.13.13b, Prescription Lenses and Visual Devices
Notification: 12/27/2017 | Effective: 03/28/2018 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

05.00.39o, Ankle-Foot/Knee-Ankle-Foot Orthoses
Notification: 12/27/2017 | Effective: 01/26/2018 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position

07.03.08g, Neuropsychological Testing for Neurologically Based Conditions
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.02.01p, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; 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.
08.01.40, Lanreotide (Somatuline® Depot)
Notification: 09/29/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: This is a new policy.

08.01.41, Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
Notification: 10/03/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
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.
00.01.55l, New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

00.03.09d, X-rays Associated with Fractures in the Office Setting
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

00.03.07t, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

00.10.01y, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

00.10.40b, Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNPs) or Physician Assistants (PAs)
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

00.03.10e, Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

00.10.15c, Cast and Splint Applications and Associated Supplies Provided in the Office Setting
Notification: 09/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

07.03.22b, Transcranial Magnetic Stimulation (TMS) for Medical Conditions
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.15.15g, Percutaneous Discectomy
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.08.15u, Reconstructive Breast Surgery
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

11.14.29b, Spinal Discectomy
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

11.08.20q, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

00.01.25ao, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

08.00.55h, Omalizumab (Xolair®)
Effective: 12/13/2017 | Posted: 12/13/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.87e, Pemetrexed (Alimta®)
Effective: 12/13/2017 | Posted: 12/13/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

05.00.38j, Negative-Pressure Wound Therapy (NPWT) Systems
Effective: 12/13/2017 | Posted: 12/13/2017
Type of policy change: General Description, Guidelines, or Informational Update

05.00.45j, Repair or Replacement of an External Prosthetic Device
Notification: 11/15/2017 | Effective: 12/15/2017 | Posted: 12/15/2017
Type of policy change: Medical Coding

11.17.04r, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Notification: 11/15/2017 | Effective: 12/15/2017 | Posted: 12/15/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

05.00.12g, Manual Wheelchairs
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.10.39h, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

08.00.97h, Histone Deacetylase Inhibitors for Peripheral T-cell Lymphoma (e.g., Istodax®, Beleodaq®)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria

08.00.34j, Infliximab and Related Biosimilars
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.29k, Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.01.25b, Ramucirumab (Cyramza®)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria

08.00.90g, Paclitaxel Protein-bound Particles for Injectable Suspension (Albumin-bound)/(Abraxane® for Injectable Suspension)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria

08.01.21b, Blinatumomab (Blincyto®)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.84d, Eculizumab (Soliris®)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.05e, Carfilzomib (Kyprolis™)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria

05.00.31d, Pulse Oximetry Devices in the Home Setting
Notification: 11/29/2017 | Effective: 12/29/2017 | Posted: 12/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.78x, Self-Administered Drugs
Notification: 10/03/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

12.01.01am, Experimental/Investigational Services
Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Medical Coding

08.01.08c, Coverage of Prescription Oral Anticancer Drugs and/or Biologics as Provided Under the Company's Medical Benefit
Notification: 09/29/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

09.00.46t NJ, High-Technology Radiology Services (AmeriHealth New Jersey)
Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

00.10.42, Telemedicine and Telehealth Services (Amerihealth New Jersey)
Effective: 07/21/2017 | Posted: 12/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.00.09f, Solid Organ Transplantation and Procurement Cost of Organs and Tissues
Notification: 12/01/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: General Description, Guidelines, or Informational Update

09.00.46t PA, High-Technology Radiology Services (AmeriHealth Pennsylvania)
Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

00.06.02u, Preventive Care Services (AmeriHealth)
Notification: 09/28/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
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.
05.00.70b, Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
Reissue Effective: 12/06/2017 | Reissue Posted: 12/06/2017

09.00.42c, Computer-Aided Detection (CAD) System for use with Chest Radiographs
Reissue Effective: 12/20/2017 | Reissue Posted: 12/20/2017

05.00.54g, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
Reissue Effective: 12/20/2017 | Reissue Posted: 12/20/2017


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.
08.01.36b, Nusinersen (Spinraza™)
Effective: 01/01/2018 | Posted: 12/29/2017

08.01.39a, Cerliponase alfa (Brineura™)
Effective: 01/01/2018 | Posted: 12/29/2017

08.01.38b, Ocrelizumab (Ocrevus™)
Effective: 01/01/2018 | Posted: 12/29/2017

08.01.43a, Chimeric Antigen Receptor (CAR) Therapy
Effective: 01/01/2018 | Posted: 12/29/2017

08.01.04q, Immunizations
Effective: 01/01/2018 | Posted: 12/29/2017

08.01.20h, 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: 01/01/2018 | Posted: 12/29/2017

09.00.56e, Radiation Therapy Services (AmeriHealth)
Effective: 01/01/2018 | Posted: 12/29/2017

11.02.10l, Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Effective: 01/01/2018 | Posted: 12/29/2017

10.03.01i, Physical Medicine, Rehabilitation, and Habilitation Services
Effective: 01/01/2018 | Posted: 12/29/2017

11.01.02m, Cochlear Implant
Effective: 01/01/2018 | Posted: 12/29/2017

11.07.01q, Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)
Effective: 01/01/2018 | Posted: 12/29/2017

11.00.16f, Radiofrequency Ablation and Cryosurgical Ablation of Lung Tumors
Effective: 01/01/2018 | Posted: 12/29/2017

11.02.19e, Total Artificial Hearts (TAHs)
Effective: 01/01/2018 | Posted: 12/29/2017

11.02.01o, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Effective: 01/01/2018 | Posted: 12/29/2017

11.02.16q, Ventricular Assist Devices (VADs)
Effective: 01/01/2018 | Posted: 12/29/2017

10.06.01k, Speech Therapy
Effective: 01/01/2018 | Posted: 12/29/2017

11.01.06d, Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
Effective: 01/01/2018 | Posted: 12/29/2017

05.00.67n, Wheelchair Options and Accessories
Effective: 01/01/2018 | Posted: 12/29/2017

05.00.45k, Repair or Replacement of an External Prosthetic Device
Effective: 01/01/2018 | Posted: 12/29/2017

05.00.72e, Upper Limb Prostheses
Effective: 01/01/2018 | Posted: 12/29/2017

06.02.26c, In Vitro Allergy Testing
Effective: 01/01/2018 | Posted: 12/29/2017

00.01.59c, Care Management and Care Planning Services
Effective: 01/01/2018 | Posted: 12/29/2017

08.00.13t, Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Effective: 01/01/2018 | Posted: 12/29/2017

07.07.03k, Photodynamic Therapy (PDT) Using Levulan® Kerastick® (Aminolevulinic Acid HCl [ALA]) or Metvixia® (Methyl Aminolevulinate [MAL])
Effective: 01/01/2018 | Posted: 12/29/2017

05.00.55i, Wheelchair Cushions and Seating
Effective: 01/01/2018 | Posted: 12/29/2017

07.10.05k, Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
Effective: 01/01/2018 | Posted: 12/29/2017

05.00.59i, Lower Limb Prostheses
Effective: 01/01/2018 | Posted: 12/29/2017

07.07.09f, 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: 01/01/2018 | Posted: 12/29/2017

05.00.26f, Home Prothrombin Time Monitoring
Effective: 01/01/2018 | Posted: 12/29/2017

06.02.01h, Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Treatment
Effective: 01/01/2018 | Posted: 12/29/2017

08.00.82j, Ustekinumab (Stelara®)
Effective: 01/01/2018 | Posted: 12/29/2017

06.02.27k, Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators)
Effective: 01/01/2018 | Posted: 12/29/2017

09.00.10x, Brachytherapy (AmeriHealth Administrators)
Effective: 01/01/2018 | Posted: 12/29/2017

11.14.07r, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
Effective: 01/01/2018 | Posted: 12/29/2017

07.03.14m, Intraoperative Neurophysiological Monitoring (INM)
Effective: 01/01/2018 | Posted: 12/29/2017

11.09.02e, Treatment of Gender Dysphoria
Effective: 01/01/2018 | Posted: 12/29/2017

08.00.57l, Complex Regional Pain Syndrome (CRPS) Parenteral Treatments
Effective: 01/01/2018 | Posted: 12/29/2017

11.16.06h, Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
Effective: 01/01/2018 | Posted: 12/29/2017

06.02.35p, Genetic Testing (AmeriHealth Administrators)
Effective: 01/01/2018 | Posted: 12/29/2017

08.00.92t, Coagulation Factors
Effective: 01/01/2018 | Posted: 12/29/2017

11.08.25m, Scar Revision
Effective: 01/01/2018 | Posted: 12/29/2017

11.15.16m, Vagus Nerve Stimulation (VNS)
Effective: 01/01/2018 | Posted: 12/29/2017

08.01.00f, Hydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies
Effective: 01/01/2018 | Posted: 12/29/2017

11.08.20r, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Effective: 01/01/2018 | Posted: 12/29/2017

07.03.07q, Evaluation and Management of Autism Spectrum Disorders (ASD)
Effective: 01/01/2018 | Posted: 12/29/2017

06.03.04n, Apheresis Therapy
Effective: 01/01/2018 | Posted: 12/29/2017


Archived Policies
AmeriHealth has determined that it is no longer necessary for the following commercial policy to remain active.
09.00.52d, Digital Breast Tomosynthesis (AmeriHealth)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

08.00.76g, Oxaliplatin (Eloxatin®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

08.01.30, Daptomycin (Cubicin®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

08.01.09d, Omacetaxine mepesuccinate (Synribo®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

08.00.79a, Plerixafor Injection (Mozobil®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

08.01.31, Fulvestrant (Faslodex®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

08.01.02c, Pegloticase (Krystexxa®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

08.00.86a, Ecallantide (Kalbitor®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017