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.
11.14.19o, Artificial Intervertebral Disc Insertion
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: General Description, Guidelines, or Informational Update

00.01.66c, Musculoskeletal Services (AmeriHealth)
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.14.03g, Meniscal Allograft Transplantation and Meniscal Implants
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.14.28c, Spinal Laminectomy
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.14.27d, Spinal Fusion
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.15.09n, Denervation of the Spinal Nerves for Chronic Pain
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.14.29f, Spinal Discectomy
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.15.01w, Spinal Cord and Dorsal Root Ganglion Stimulation
Notification: 03/11/2020 (Revised 06/12/2020) | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.15.23i, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
Notification: 03/11/2020 (Revised 06/12/2020) | Effective: 06/15/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.25i, Cranial Remolding Orthoses (Helmets)
Notification: 03/20/2020 | Effective: 04/20/2020 | Posted: 03/20/2020
Type of policy change: Medical Necessity Criteria


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.
08.00.10, Luspatercept–aamt (Reblozyl®)
Effective: 03/09/2020 | Posted: 03/09/2020
Type of policy change: This is a new policy.

08.00.12, Fam-trastuzumab deruxtecan-nxki (Enhertu®)
Effective: 03/09/2020 | Posted: 03/09/2020
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.
08.00.91d, Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP™, Glassia™, Zemaira™)
Notification: 12/03/2019 | Effective: 03/02/2020 | Posted: 03/02/2020
Type of policy change: Medical Necessity Criteria; Medical Coding

09.00.04k, Bone Mineral Density (BMD) Testing
Effective: 03/11/2020 | Posted: 03/11/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.03.22d, Transcranial Magnetic Stimulation (TMS)
Notification: 12/17/2019 | Effective: 07/01/2019 | Posted: 03/16/2020
Type of policy change: Medical Necessity Criteria

00.10.03j, Criteria for Reimbursement of Emergency Room Services
Effective: 03/23/2020 | Posted: 03/23/2020
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

09.00.36l, First-Trimester Prenatal Screening for Fetal Aneuploidy Using Fetal Ultrasound Markers
Effective: 03/23/2020 | Posted: 03/23/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

11.00.10w, Multiple Surgery Payment Reduction
Notification: 12/30/2019 | Effective: 03/30/2020 | Posted: 03/30/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
11.00.02f, Treatment of Medical and Surgical Complications
Reissue Effective: 03/12/2020 | Reissue Posted: 03/12/2020

11.08.04h, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
Reissue Effective: 03/11/2020 | Reissue Posted: 03/12/2020

11.14.24b, Manipulation Under Anesthesia
Reissue Effective: 03/11/2020 | Reissue Posted: 03/12/2020

11.14.14e, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
Reissue Effective: 03/11/2020 | Reissue Posted: 03/12/2020

11.15.22d, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Reissue Effective: 03/11/2020 | Reissue Posted: 03/12/2020

06.02.09g, Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (AmeriHealth Administrators)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.29d, AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.04d, Fetal Fibronectin Enzyme (fFN) Immunoassay
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.17g, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.31f, Genetic Testing for Congenital Long QT Syndrome (AmeriHealth Administrators)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.44l, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.47c, Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (AmeriHealth Administrators)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.45, Vectra® DA Blood Test for Rheumatoid Arthritis
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.38d, Nerve Fiber Density Testing
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.35w, Genetic Testing (AmeriHealth Administrators)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

08.00.51j, Enzyme Replacement for the Treatment of Gaucher's Disease
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

07.06.03b, Bioimpedance for the Detection of Lymphedema
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

07.06.01b, Complete Decongestive Therapy (CDT)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.50, GPS Cancer™ Testing by NantHealth
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

06.02.55, Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

11.11.01i, Evaluation and Treatment of Erectile Dysfunction (ED)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

08.01.39c, Cerliponase alfa (Brineura®)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

08.00.70e, Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase®, Vimizim®, Naglazyme®, Mepsevii™, etc.)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

11.00.13g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

11.11.03d, Cryosurgical Ablation of the Prostate Gland
Reissue Effective: 03/25/2020 | Reissue Posted: 03/25/2020

07.13.12d, Instrument-Based Vision Screening
Reissue Effective: 03/25/2020 | Reissue Posted: 03/26/2020

09.00.51a, Positron Emission Mammography (PEM)
Reissue Effective: 03/25/2020 | Reissue Posted: 03/26/2020


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.
00.03.02z, Diagnostic Radiology Services Included in Capitation
Effective: 01/01/2020 | Posted: 03/10/2020


Archived Policies
AmeriHealth has determined that it is no longer necessary for the following commercial policy to remain active.
06.03.05e, Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)
Notification: 03/20/2020 | Archive Effective: 04/20/2020 | Posted: 03/20/2020