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.
03.00.33, Modifier 53: Discontinued Procedure
Notification: 07/01/2016 | Effective: 10/01/2016 | Posted: 07/01/2016
Type of policy change: This is a new policy.

00.01.52d, Always Bundled Procedure Codes
Notification: 07/01/2016 | Effective: 10/01/2016 | Posted: 07/01/2016
Type of policy change: Medical Coding

12.01.01ah, Experimental/Investigational Services
Notification: 07/01/2016 (revised 07/20/2016) | Effective: 10/01/2016 | Posted: 07/01/2016
Type of policy change: Medical Coding

07.02.09d, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Notification: 07/01/2016 | Effective: 08/01/2016 | Posted: 07/01/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.06.02q, Preventive Care Services
Notification: 07/01/2016 (revised 07/08/2016) | Effective: 08/01/2016 | Posted: 07/01/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.00.92p, Coagulation Factors
Notification: 07/08/2016 | Effective: 08/08/2016 | Posted: 07/08/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

10.03.01f, Physical Medicine, Rehabilitation, and Habilitation Services
Notification: 07/14/2016 | Effective: 10/12/2016 | Posted: 07/14/2016
Type of policy change: Coverage and/or Reimbursement Position

07.03.07o, Evaluation and Management of Autism Spectrum Disorders (ASD)
Notification: 07/20/2016 | Effective: 08/19/2016 | Posted: 07/20/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.70b, Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
Notification: 07/27/2016 | Effective: 08/26/2016 | Posted: 07/27/2016


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.
06.02.52, eviCore Lab Management Program
Notification: 05/02/2016 | Effective: 07/01/2016 | Posted: 07/01/2016
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.
12.01.01ag, Experimental/Investigational Services
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: Medical Coding

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

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

07.03.14k, Intraoperative Neurophysiological Monitoring (INM)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

06.02.09g, Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

00.06.02q, Preventive Care Services
Notification: 07/01/2016 | Effective: 08/01/2016 | Posted: 07/01/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

06.02.06o, Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.27j, Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.36b, PathFinderTG® (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.24i, Preimplantation Genetic Testing (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.30e, Pharmacogenetic Testing to Determine Drug Sensitivity (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.31e, Genetic Testing for Congenital Long QT Syndrome (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.29d, AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.47a, Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.10p, Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.18k, Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.32d, Multigene Expression Assays for Predicting Recurrence in Colon Cancer (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

06.02.35j, Genetic Testing (AmeriHealth Administrators)
Effective: 07/01/2016 | Posted: 07/01/2016
Type of policy change: General Description, Guidelines, or Informational Update

08.01.01e, Ipilimumab (Yervoy®)
Effective: 07/05/2016 | Posted: 07/05/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.56h, Hospital Beds and Accessories
Effective: 07/13/2016 | Posted: 07/13/2016
Type of policy change: General Description, Guidelines, or Informational Update

07.13.13a, Prescription Lenses and Visual Devices
Effective: 07/20/2016 | Posted: 07/20/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
07.03.03f, IMedical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD)
Reissue Effective: 07/06/2016 | Reissue Posted: 07/06/2016

11.16.07a, Bronchial Thermoplasty
Reissue Effective: 07/06/2016 | Reissue Posted: 07/07/2016

07.03.22a, Repetitive Transcranial Magnetic Stimulation (rTMS)
Reissue Effective: 07/06/2016 | Reissue Posted: 07/07/2016

11.11.03d, Cryosurgical Ablation of the Prostate Gland
Reissue Effective: 07/06/2016 | Reissue Posted: 07/07/2016

11.11.06g, Saturation Needle Biopsy of the Prostate
Reissue Effective: 07/06/2016 | Reissue Posted: 07/07/2016

11.01.01i, Otoplasty
Reissue Effective: 07/06/2016 | Reissue Posted: 07/07/2016

00.01.18c, Reimbursement for Associated Services Performed in Conjunction with Dental Care
Reissue Effective: 07/20/2016 | Reissue Posted: 07/20/2016


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.
09.00.32p, Diagnostic and Therapeutic Radiopharmaceutical Agents
Effective: 07/01/2016 | Posted: 07/01/2016