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.
00.06.02ac, Preventive Care Services (AmeriHealth)
Notification: 04/01/2020 (Revised  06/29/2020) | Effective: 07/01/2020 | Posted: 04/01/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

05.00.35f, Foot Orthotics and Other Podiatric Appliances
Notification: 04/03/2020 | Effective: 05/04/2020 | Posted: 04/03/2020
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.
08.00.43, Enfortumab vedotin-ejfv (Padcev™)
Effective: 04/06/2020 | Posted: 04/06/2020
Type of policy change: This is a new policy.

00.01.69, Consultation Services
Notification: 01/15/2020 | Effective: 04/15/2020 | Posted: 04/15/2020
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.
10.03.01l, Physical Medicine, Rehabilitation, and Habilitation Services
Effective: 04/01/2020 | Posted: 04/01/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

00.03.02aa, Diagnostic Radiology Services Included in Capitation
Effective: 04/01/2020 | Posted: 04/08/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

12.01.01av, Experimental/Investigational Services
Effective: 04/01/2020 | Posted: 04/10/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

11.00.06k, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring
Effective: 03/15/2020 | Posted: 04/10/2020
Type of policy change: Medical Necessity Criteria; Medical Coding

03.00.06r, 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
Notification: 12/31/2019 | Effective: 04/15/2020 | Posted: 04/15/2020
Type of policy change: Coverage and/or Reimbursement Position; 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: 04/15/2020
Type of policy change: Medical Coding

00.01.14r, Reporting and Documentation Requirements for Anesthesia Services
Notification: 01/22/2020 | Effective: 04/20/2020 | Posted: 04/20/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.84g, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®)
Effective: 04/20/2020 | Posted: 04/20/2020
Type of policy change: 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: 04/20/2020
Type of policy change: Medical Necessity Criteria

06.02.01j, Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy
Effective: 04/20/2020 | Posted: 04/20/2020
Type of policy change: General Description, Guidelines, or Informational Update

07.10.05m, Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
Effective: 04/20/2020 | Posted: 04/21/2020
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

08.00.74n, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars
Effective: 04/27/2020 | Posted: 04/27/2020
Type of policy change: 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.
08.01.24, Deoxycholic Acid (Kybella™)
Reissue Effective: 04/08/2020 | Reissue Posted: 04/08/2020

07.00.14g, Low-level Laser Therapy (LLLT)
Reissue Effective: 04/08/2020 | Reissue Posted: 04/08/2020

11.08.17i, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Reissue Effective: 04/08/2020 | Reissue Posted: 04/08/2020

07.03.15d, Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)
Reissue Effective: 04/08/2020 | Reissue Posted: 04/08/2020

07.05.06g, Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

08.00.72h, Alglucosidase alfa (e.g., Lumizyme®)
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

08.00.69b, Agalsidase beta (Fabrazyme®)
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

07.03.26a, Tumor Treating Fields
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

05.00.59j, Lower Limb Prostheses
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

11.06.02i, Elective Abortion
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

11.06.04k, Uterine Artery Embolization
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

11.06.05f, Endometrial Ablation
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

08.01.41c, Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

08.01.54b, Emapalumab-lzsg (Gamifant®)
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

11.08.15x, Reconstructive Breast Surgery
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

11.11.06h, Saturation Needle Biopsy of the Prostate
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

07.02.09g, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Reissue Effective: 04/08/2020 | Reissue Posted: 04/09/2020

11.06.07d, Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
Reissue Effective: 04/09/2020 | Reissue Posted: 04/09/2020

11.14.13g, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Reissue Effective: 04/22/2020 | Reissue Posted: 04/23/2020

08.01.46a, Ibalizumab-uiyk (Trogarzo™)
Reissue Effective: 04/23/2020 | Reissue Posted: 04/23/2020

08.01.08d, Coverage of Prescription Oral Anticancer Drugs and/or Biologics as Provided Under the Company's Medical Benefit
Reissue Effective: 04/23/2020 | Reissue Posted: 04/23/2020

11.14.17d, Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedures
Reissue Effective: 04/22/2020 | Reissue Posted: 04/23/2020


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.
00.01.25aw, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 04/01/2020 (Revised 05/04/2020) | Posted: 04/01/2020

06.02.17h, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Effective: 04/01/2020 | Posted: 04/02/2020

00.10.41g, Telemedicine Services (Amerihealth Pennsylvania)
Effective: 04/01/2020 | Posted: 04/02/2020

03.00.05k, Modifier 50: Bilateral Procedure
Effective: 04/01/2020 | Posted: 04/02/2020

06.02.44m, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Effective: 04/01/2020 | Posted: 04/02/2020

06.02.18l, Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (AmeriHealth Administrators)
Effective: 04/01/2020 | Posted: 04/02/2020

06.02.35x, Genetic Testing (AmeriHealth Administrators)
Effective: 04/01/2020 | Posted: 04/02/2020

11.03.12s, Colorectal Cancer Screening
Effective: 04/01/2020 | Posted: 04/03/2020

06.02.56b, Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease
Effective: 04/01/2020 | Posted: 04/03/2020

06.02.52p, eviCore Lab Management Program (AmeriHealth)
Effective: 04/01/2020 | Posted: 04/03/2020

08.01.32b, Pegfilgrastim (Neulasta®) and Related Biosimilars
Effective: 04/01/2020 | Posted: 04/03/2020

06.02.47d, Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (AmeriHealth Administrators)
Effective: 04/01/2020 | Posted: 04/03/2020

00.03.07y, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 04/01/2020 (Revised 05/04/2020) | Posted: 04/10/2020

03.00.20j, Modifiers 26 (Professional Component) and TC (Technical Component)
Effective: 01/01/2020 | Posted: 04/21/2020


Archived Policies
AmeriHealth has determined that it is no longer necessary for the following commercial policy to remain active.
11.00.11k, Use of an Operating Microscope During a Surgical Procedure
Notification: 04/17/2020 | Archive Effective: 05/18/2020 | Posted: 04/17/2020