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.
09.00.46w NJ, High-Technology Radiology Services (AmeriHealth New Jersey)
Notification: 04/01/2019 | Effective: 07/01/2019 | Posted: 04/01/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

11.02.27b, Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (AmeriHealth)
Notification: 04/01/2019 | Effective: 07/01/2019 | Posted: 04/01/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

09.00.56i, Radiation Therapy Services (AmeriHealth)
Notification: 04/01/2019 | Effective: 07/01/2019 | Posted: 04/01/2019
Type of policy change: General Description, Guidelines, or Informational Update

09.00.46w PA, High-Technology Radiology Services (AmeriHealth Pennsylvania)
Notification: 04/01/2019 | Effective: 07/01/2019 | Posted: 04/01/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

11.02.27a, Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (AmeriHealth)
Notification: 04/01/2019 | Effective: 05/01/2019 | Posted: 04/01/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

08.00.84e, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)
Notification: 04/02/2019 (Revised 06/18/2019) | Effective: 07/01/2019 | Posted: 04/02/2019
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.07.03m, Photodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])
Notification: 04/02/2019 | Effective: 07/01/2019 | Posted: 04/02/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.25k, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Notification: 04/08/2019 | Effective: 05/06/2019 | Posted: 04/08/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.54, Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
Notification: 04/29/2019 | Effective: 05/28/2019 | Posted: 04/29/2019
Type of policy change: This is a new policy.

11.08.20t, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Notification: 04/30/2019 | Effective: 07/29/2019 | Posted: 04/30/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.03.05v, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies (AmeriHealth)
Notification: 04/30/2019 | Effective: 06/29/2019 | Posted: 04/30/2019
Type of policy change: 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.
08.01.55, Tagraxofusp-erzs (Elzonris™)
Effective: 04/15/2019 | Posted: 04/15/2019
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.
05.00.25h, Cranial Remolding Orthoses (Helmets)
Effective: 04/01/2019 | Posted: 04/01/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.14.02n, Trigger Point Injections
Notification: 01/02/2019 | Effective: 04/01/2019 | Posted: 04/01/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.02.01r, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Effective: 04/01/2019 | Posted: 04/01/2019
Type of policy change: General Description, Guidelines, or Informational Update

08.00.94k, Denosumab (Prolia®, Xgeva®)
Effective: 04/08/2019 | Posted: 04/08/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.10.41e, Telemedicine Services (Amerihealth PA)
Effective: 01/02/2019 | Posted: 04/12/2019
Type of policy change: Medical Necessity Criteria; Medical Coding

00.10.42b, Telemedicine and Telehealth Services (Amerihealth New Jersey)
Effective: 01/02/2019 | Posted: 04/12/2019
Type of policy change: Medical Necessity Criteria; Medical Coding

08.00.73l, Bortezomib (Bortezomib for Injection, Velcade®)
Effective: 04/15/2019 | Posted: 04/15/2019
Type of policy change: Medical Necessity Criteria; Medical Coding

05.00.72f, Upper Limb Prostheses
Effective: 04/15/2019 | Posted: 04/15/2019
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

11.09.02g, Treatment of Gender Dysphoria
Effective: 04/15/2019 | Posted: 04/15/2019
Type of policy change: Coverage and/or Reimbursement Position

08.01.32a, Pegfilgrastim (Neulasta®) and Related Biosimilars
Effective: 04/22/2019 | Posted: 04/22/2019
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

08.00.34m, Infliximab and Related Biosimilars
Effective: 04/22/2019 | Posted: 04/22/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.00.85h, Tocilizumab (Actemra®) for Intravenous Infusion
Effective: 04/22/2019 | Posted: 04/22/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.03.05d, Frenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)
Effective: 04/29/2019 | Posted: 04/29/2019
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.
08.01.22c, Alemtuzumab (Lemtrada®)
Reissue Effective: 04/10/2019 | Reissue Posted: 04/11/2019

11.08.17h, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Reissue Effective: 04/10/2019 | Reissue Posted: 04/11/2019

08.01.46a, Ibalizumab-uiyk (Trogarzo™)
Reissue Effective: 04/10/2019 | Reissue Posted: 04/11/2019

11.08.19m, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Reissue Effective: 04/10/2019 | Reissue Posted: 04/11/2019

11.06.02i, Elective Abortion
Reissue Effective: 04/10/2019 | Reissue Posted: 04/11/2019

07.03.08i, Neuropsychological Testing for Neurologically Based Conditions
Reissue Effective: 04/24/2019 | Reissue Posted: 04/25/2019

07.08.03d, Medical and Surgical Treatment of Temporomandibular Joint Disorder
Reissue Effective: 04/25/2019 | Reissue Posted: 04/25/2019

11.11.01i, Evaluation and Treatment of Erectile Dysfunction (ED)
Reissue Effective: 04/25/2019 | Reissue Posted: 04/25/2019

07.03.23b, Autonomic Nervous System Testing
Reissue Effective: 04/25/2019 | Reissue Posted: 04/25/2019


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.
08.01.53a, Moxetumomab Pasudotox-tdfk (Lumoxiti™)
Effective: 04/01/2019 | Posted: 04/01/2019

08.00.92y, Coagulation Factors
Effective: 04/01/2019 | Posted: 04/01/2019

00.06.02y, Preventive Care Services (AmeriHealth)
Effective: 01/02/2019 | Posted: 04/15/2019

03.00.20i, Modifiers 26 (Professional Component) and TC (Technical Component)
Effective: 01/01/2019 | Posted: 04/26/2019


Archived Policies
AmeriHealth has determined that it is no longer necessary for the following commercial policy to remain active.
05.00.65e, Home Uterine Activity Monitoring (HUAM) Devices
Notification: 04/05/2019 | Archive Effective: 05/06/2019 | Posted: 04/05/2019