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.
05.00.72d, Upper Limb Prostheses
Notification: 06/01/2016 | Effective: 07/01/2016 | Posted: 06/01/2016
Type of policy change: Medical Necessity Criteria

05.00.58I, Home Oxygen Therapy
Notification: 06/01/2016 | Effective: 07/01/2016 | Posted: 06/01/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.03.09k, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Notification: 06/02/2016 | Effective: 08/01/2016 | Posted: 06/02/2016
Type of policy change: Medical Coding

07.03.18j, Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Notification: 06/02/2016 | Effective: 08/01/2016 | Posted: 06/02/2016
Type of policy change: Medical Coding


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.
11.15.20l, Deep Brain Stimulation (DBS)
Notification: 05/02/2016 | Effective: 06/01/2016 | Posted: 06/01/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.01.07c, Cataract Surgery
Effective: 06/01/2016 | Posted: 06/01/2016
Type of policy change: Medical Necessity Criteria

05.00.42g, Patient Lifts
Notification: 05/04/2016 | Effective: 06/03/2016 | Posted: 06/03/2016

06.02.43a, Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)
Effective: 06/06/2016 | Posted: 06/06/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.38c, Nerve Fiber Density Testing
Effective: 06/06/2016 | Posted: 06/06/2016
Type of policy change: General Description, Guidelines, or Informational Update

02.01.02c, Private Duty Nursing
Notification: 03/09/2016 | Effective: 06/07/2016 | Posted: 06/07/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.16.06g, Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
Effective: 06/15/2016 | Posted: 06/15/2016
Type of policy change: General Description, Guidelines, or Informational Update

08.01.23b, Interleukin-5 Antagonist for Severe Eosinophilic Asthma (e.g., Nucala®, Cinqair®)
Effective: 06/15/2016 | Posted: 06/15/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.00.21g, Allergy Immunotherapy
Effective: 06/20/2016 | Posted: 06/20/2016
Type of policy change: General Description, Guidelines, or Informational Update

09.00.17m, Intensity-Modulated Radiation Therapy (IMRT) (AmeriHealth Administrators)
Effective: 06/20/2016 | Posted: 06/20/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

06.02.39b, Measurement of Serum Antibodies to and Measurement of Serum Levels of Infliximab and Adalimumab
Effective: 06/20/2016 | Posted: 06/20/2016
Type of policy change: General Description, Guidelines, or Informational Update

08.00.49d, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Effective: 06/29/2016 | Posted: 06/29/2016
Type of policy change: Medical Coding

08.00.55g, Omalizumab (Xolair®)
Effective: 06/29/2016 | Posted: 06/29/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
07.05.06f, Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Reissue Effective: 06/22/2016 | Reissue Posted: 06/22/2016

07.05.07c, Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
Reissue Effective: 06/22/2016 | Reissue Posted: 06/22/2016

11.00.13e, Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Reissue Effective: 06/22/2016 | Reissue Posted: 06/22/2016

08.00.79a, Plerixafor Injection (Mozobil®)
Reissue Effective: 06/22/2016 | Reissue Posted: 06/23/2016

08.01.24, Deoxycholic Acid (Kybella™)
Reissue Effective: 06/22/2016 | Reissue Posted: 06/23/2016

11.01.06b, Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
Reissue Effective: 06/22/2016 | Reissue Posted: 06/23/2016

11.01.02k, Cochlear Implant
Reissue Effective: 06/22/2016 | Reissue Posted: 06/23/2016

07.13.11e, Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
Reissue Effective: 06/22/2016 | Reissue Posted: 06/23/2016

07.13.08c, Partial Coherence Interferometry
Reissue Effective: 06/22/2016 | Reissue Posted: 06/23/2016


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.
00.01.25ae, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 06/10/2016 | Posted: 06/10/2016

08.01.29a, Daratumumab (Darzalex™)
Effective: 07/01/2016 | Posted: 06/30/2016

08.01.28a, Sebelipase alfa (Kanuma®)
Effective: 07/01/2016 | Posted: 06/30/2016