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.
06.02.55, Therapeutic Drug Monitoring for Antidepressants, Antipsychotics or Antiepileptics
Notification: 03/08/2017 (revised 03/28/2017) | Effective: 04/07/2017 | Posted: 03/09/2017
Type of policy change: This is a new policy.


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.
06.02.56, Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease
Effective: 03/01/2017 | Posted: 03/01/2017
Type of policy change: This is a new policy.

08.01.33, Gonadotropin-Releasing Hormone Agonist (Eligard®, Lupron Depot®)
Notification: 12/14/2016 | Effective: 03/14/2017 | Posted: 03/14/2017
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.
12.01.01aj, Experimental/Investigational Services
Effective: 03/01/2017 | Posted: 03/01/2017
Type of policy change: Medical Coding

08.00.98d, Eribulin Mesylate (Halaven®)
Effective: 03/08/2017 | Posted: 03/08/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.34i, Infliximab and related biosimilars
Effective: 03/08/2017 | Posted: 03/08/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.10.05h, Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
Effective: 03/08/2017 | Posted: 03/08/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

08.00.94i, Denosumab (Prolia ®, Xgeva®)
Notification: 12/15/2016 | Effective: 03/14/2017 | Posted: 03/14/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

05.00.71c, Standing Frames
Effective: 03/22/2017 | Posted: 03/22/2017
Type of policy change: General Description, Guidelines, or Informational Update

05.00.60f, Pressure-Reducing Support Surfaces
Effective: 03/22/2017 | Posted: 03/22/2017
Type of policy change: General Description, Guidelines, or Informational Update

11.00.06g, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults
Notification: 02/24/2017 | Effective: 03/24/2017 | Posted: 03/24/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

08.00.74j, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (eg, ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], aflibercept [Eylea®])
Notification: 12/28/2016 | Effective: 03/28/2017 | Posted: 03/28/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
05.00.69b, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)
Reissue Effective: 03/01/2017 | Reissue Posted: 03/02/2017

07.00.14f, Low-level Laser Therapy (LLLT)
Reissue Effective: 03/01/2017 | Reissue Posted: 03/02/2017

07.07.03j, Photodynamic Therapy (PDT) Using Levulan® Kerastick® (Aminolevulinic Acid HCl [ALA]) or Metvixia® (Methyl Aminolevulinate [MAL])
Reissue Effective: 03/01/2017 | Reissue Posted: 03/02/2017

07.07.02i, Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Reissue Effective: 03/01/2017 | Reissue Posted: 03/02/2017

11.08.04h, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
Reissue Effective: 03/01/2017 | Reissue Posted: 03/02/2017

05.00.08d, Continuous Passive Motion (CPM) Devices in the Home Setting
Reissue Effective: 03/15/2017 | Reissue Posted: 03/15/2017

05.00.75, Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Reissue Effective: 03/29/2016 | Reissue Posted: 03/29/2017

11.11.03d, Cryosurgical Ablation of the Prostate Gland
Reissue Effective: 03/29/2017 | Reissue Posted: 03/29/2017

05.00.78, Transtympanic Micropressure Device as a Treatment of Meniere Disease
Reissue Effective: 03/29/2017 | Reissue Posted: 03/29/2017

05.00.76a, Breast Pumps
Reissue Effective: 03/29/2017 | Reissue Posted: 03/29/2017

07.02.09e, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Reissue Effective: 03/29/2017 | Reissue Posted: 03/29/2017

11.00.01e, Revision of a Previous Cosmetic Procedure
Reissue Effective: 03/29/2017 | Reissue Posted: 03/29/2017

11.08.02g, Reduction Mammoplasty
Reissue Effective: 03/29/2017 | Reissue Posted: 03/29/2017

11.08.12h, Surgery for Gynecomastia
Reissue Effective: 03/29/2017 | Reissue Posted: 03/29/2017

11.08.14i, Removal of Breast Implants
Reissue Effective: 03/29/2017 | Reissue Posted: 03/29/2017


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.
08.00.82f, Ustekinumab (Stelara®)
Effective: 01/01/2017 | Posted: 03/22/2017

08.00.82g, Ustekinumab (Stelara®)
Effective: 04/01/2017 | Posted: 03/31/2017