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

 
Aug 2020  Jul 2020  Jun 2020  May 2020  Apr 2020  Mar 2020  Feb 2020  Jan 2020  Dec 2019  Nov 2019  Oct 2019  Sep 2019  Aug 2019  Jul 2019  Jun 2019  May 2019  Apr 2019  Mar 2019  Feb 2019  Jan 2019  Dec 2018  Nov 2018  Oct 2018  Sep 2018  Aug 2018  Jul 2018  Jun 2018  May 2018  Apr 2018  Mar 2018  Feb 2018  Jan 2018  Dec 2017  Nov 2017  Oct 2017  Sep 2017  Aug 2017  Jul 2017  Jun 2017  May 2017  Apr 2017  Mar 2017  Feb 2017  Jan 2017  Dec 2016  Nov 2016  Oct 2016  Sep 2016  Aug 2016  Jul 2016  Jun 2016  May 2016  Apr 2016  Mar 2016  Feb 2016  Jan 2016  Dec 2015  Nov 2015  Oct 2015  Sep 2015  Aug 2015  Jul 2015  Jun 2015  

Notifications
The following AmeriHealth commercial policies have been posted prior to their effective date.
05.00.14k, High-Frequency Chest Wall Oscillation Devices
Notification: 07/02/2020 | Effective: 08/03/2020 | Posted: 07/02/2020
Type of policy change: Medical Necessity Criteria

05.00.15r, Nebulizers and Inhalation Solutions
Notification: 07/02/2020 | Effective: 08/03/2020 | Posted: 07/02/2020
Type of policy change: Medical Necessity Criteria; Medical Coding

00.10.36r, Radiologic Guidance and/or Supervision and Interpretation of a Procedure
Notification: 07/14/2020 | Effective: 10/12/2020 | Posted: 07/14/2020
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

05.00.38k, Negative-Pressure Wound Therapy (NPWT) Systems
Notification: 07/17/2020 | Effective: 08/17/2020 | Posted: 07/17/2020
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.58m, Home Oxygen Therapy
Notification: 07/17/2020 | Effective: 08/17/2020 | Posted: 07/17/2020
Type of policy change: Medical Necessity Criteria

05.00.79c, Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems
Notification: 07/28/2020 | Effective: 10/26/2020 | Posted: 07/28/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.24r, Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)
Notification: 07/28/2020 | Effective: 10/26/2020 | Posted: 07/28/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

09.00.56k, Radiation Therapy Services (AmeriHealth)
Notification: 07/31/2020 | Effective: 10/01/2020 | Posted: 07/31/2020
Type of policy change: Coverage and/or Reimbursement Position


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.
07.03.01, Home-Based Sleep Studies
Effective: 07/18/2020 | Posted: 07/17/2020
Type of policy change: This is a new policy.

08.01.66, Cemiplimab-rwlc (LIBTAYO®)
Effective: 07/20/2020 | Posted: 07/20/2020
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.
00.06.02ac, Preventive Care Services (AmeriHealth)
Notification: 04/01/2020 | Effective: 07/01/2020 | Posted: 07/01/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

06.02.52q, eviCore Lab Management Program (AmeriHealth)
Notification: 06/01/2020 | Effective: 07/01/2020 | Posted: 07/01/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.96e, Cabazitaxel (Jevtana®)
Effective: 07/06/2020 | Posted: 07/07/2020
Type of policy change: Medical Necessity Criteria

05.00.01m, Pneumatic Compression Therapy Devices
Effective: 07/06/2020 | Posted: 07/07/2020
Type of policy change: Medical Necessity Criteria

05.00.32j, Speech and Non-Speech Generating Devices
Effective: 07/06/2020 | Posted: 07/07/2020
Type of policy change: Medical Necessity Criteria

07.03.05x, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies (AmeriHealth)
Effective: 07/18/2020 | Posted: 07/17/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

12.01.01aw, Experimental/Investigational Services
Effective: 07/01/2020 | Posted: 07/17/2020
Type of policy change: Medical Coding

05.00.29l, Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
Notification: 06/18/2020 | Effective: 07/20/2020 | Posted: 07/20/2020
Type of policy change: Medical Necessity Criteria

08.01.29f, Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)
Effective: 07/20/2020 | Posted: 07/20/2020
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

12.01.02a, Medical Necessity
Effective: 07/20/2020 | Posted: 07/20/2020
Type of policy change: Coverage and/or Reimbursement Position

08.00.13x, Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Effective: 07/20/2020 | Posted: 07/20/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
05.00.37f, Compression Garments
Reissue Effective: 07/01/2020 | Reissue Posted: 07/04/2020

12.00.01f, Acupuncture (AmeriHealth)
Reissue Effective: 07/01/2020 | Reissue Posted: 07/04/2020

12.04.03c, Air Ambulance Services
Reissue Effective: 07/06/2020 | Reissue Posted: 07/06/2020

12.04.02i, Ground Ambulance Services (Emergency and Nonemergency) (AmeriHealth)
Reissue Effective: 07/06/2020 | Reissue Posted: 07/06/2020

12.04.04a, Acute Care Facility Inpatient Transfers
Reissue Effective: 07/06/2020 | Reissue Posted: 07/06/2020

11.08.19o, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Reissue Effective: 07/06/2020 | Reissue Posted: 07/06/2020

07.00.10i, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Reissue Effective: 07/06/2020 | Reissue Posted: 07/06/2020

07.12.01e, Pelvic Floor Stimulation as a Treatment of Incontinence
Reissue Effective: 07/06/2020 | Reissue Posted: 07/06/2020

11.15.15g, Percutaneous Discectomy
Reissue Effective: 07/15/2020 | Reissue Posted: 07/15/2020

11.14.22d, Spinal Decompression with Interspinous and Interlaminar Devices
Reissue Effective: 07/15/2020 | Reissue Posted: 07/15/2020

06.02.27l, Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators)
Reissue Effective: 07/15/2020 | Reissue Posted: 07/15/2020

06.02.49b, VeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer
Reissue Effective: 07/15/2020 | Reissue Posted: 07/15/2020

05.00.31e, Pulse Oximetry Devices in the Home Setting
Reissue Effective: 07/15/2020 | Reissue Posted: 07/15/2020

06.02.54, Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
Reissue Effective: 07/16/2020 | Reissue Posted: 07/16/2020

11.16.07b, Bronchial Thermoplasty
Reissue Effective: 07/16/2020 | Reissue Posted: 07/16/2020

06.02.51c, Testing Serum Vitamin D Levels
Reissue Effective: 07/16/2020 | Reissue Posted: 07/16/2020

08.00.49e, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Reissue Effective: 07/16/2020 | Reissue Posted: 07/16/2020


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.
08.01.36e, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)
Effective: 07/01/2020 | Posted: 07/01/2020

09.00.46ab, High-Technology Radiology Services (AmeriHealth)
Effective: 07/01/2020 | Posted: 07/01/2020

06.02.06q, Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)
Effective: 07/01/2020 | Posted: 07/02/2020

08.00.10b, Luspatercept–aamt (Reblozyl®)
Effective: 07/01/2020 | Posted: 07/02/2020

08.00.13w, Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Effective: 07/01/2020 | Posted: 07/02/2020

08.00.12a, Fam-trastuzumab deruxtecan-nxki (Enhertu®)
Effective: 07/01/2020 | Posted: 07/02/2020

06.02.35y, Genetic Testing (AmeriHealth Administrators)
Effective: 07/01/2020 | Posted: 07/02/2020

08.00.92ab, Coagulation Factors
Effective: 07/01/2020 | Posted: 07/03/2020

08.01.24a, Deoxycholic Acid (Kybella™)
Effective: 07/01/2001 | Posted: 07/03/2020

08.00.45a, Eptinezumab-jjmr (VYEPTI™)
Effective: 07/01/2020 | Posted: 07/03/2020

08.01.32c, Pegfilgrastim (Neulasta®) and Related Biosimilars
Effective: 07/01/2020 | Posted: 07/03/2020

11.14.07v, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
Effective: 07/01/2020 | Posted: 07/03/2020

08.00.78ae, Self-Administered Drugs
Effective: 07/01/2020 | Posted: 07/03/2020

08.00.43a, Enfortumab vedotin-ejfv (Padcev™)
Effective: 07/01/2020 | Posted: 07/03/2020

11.16.08d, Implantable Steroid-Eluting Sinus Stents
Effective: 07/01/2020 | Posted: 07/03/2020

08.00.34n, Infliximab and Related Biosimilars
Effective: 07/01/2020 | Posted: 07/03/2020

08.00.50v, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Effective: 07/01/2020 | Posted: 07/03/2020

11.08.20v, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Effective: 07/01/2020 | Posted: 07/03/2020

03.00.05l, Modifier 50: Bilateral Procedure
Effective: 07/01/2020 | Posted: 07/07/2020

00.10.17j, Modifier 66: Surgical Team
Effective: 07/01/2020 | Posted: 07/07/2020

00.10.11m, Modifier 62: Two Surgeons
Effective: 07/01/2020 | Posted: 07/13/2020

03.00.06s, 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
Effective: 07/01/2020 | Posted: 07/13/2020

00.10.18l, Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
Effective: 07/01/2020 | Posted: 07/13/2020

00.03.07z, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 07/01/2020 | Posted: 07/17/2020

00.01.25ay, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 07/01/2020 | Posted: 07/17/2020