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.
08.01.39, Cerliponase alfa (Brineura™)
Notification: 08/09/2017 | Effective: 09/08/2017 | Posted: 08/09/2017
Type of policy change: This is a new policy.

11.15.01r, Spinal Cord and Dorsal Root Ganglion Stimulation
Notification: 08/23/2017 | Effective: 11/21/2017 | Posted: 08/23/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; 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.
08.01.37, Drugs Used for the Maintenance Treatment of Opioid or Alcohol Use Disorder (e.g., Probuphine Implant, Vivitrol Injection)
Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: This is a new policy.

07.03.23, Autonomic Nervous System Testing
Notification: 05/03/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: This is a new policy.

08.01.38, Ocrelizumab (Ocrevus™)
Notification: 07/24/2017 | Effective: 08/23/2017 | Posted: 08/23/2017
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.
00.01.55k, New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.01.25al, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.03.09c, X-rays Associated with Fractures in the Office Setting
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.10.40a, Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNP)
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.10.01w, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.03.07q, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.03.10c, Obstetrical Ultrasounds for Members enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) product
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

03.00.06n, 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: 05/01/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

06.02.44c, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.05.01e, Refractive Keratoplasty
Effective: 08/02/2017 | Posted: 08/02/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.13.06i, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Effective: 02/27/2017 | Posted: 08/23/2017
Type of policy change: Medical Coding

07.13.08d, Partial Coherence Interferometry
Effective: 08/23/2017 | Posted: 08/23/2017
Type of policy change: Medical Coding

11.07.01p, Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)
Effective: 08/25/2017 | Posted: 08/25/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
06.02.51, Testing Serum Vitamin D Levels
Reissue Effective: 08/14/2017 | Reissue Posted: 08/14/2017

07.05.07c, Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
Reissue Effective: 08/14/2017 | Reissue Posted: 08/14/2017

07.05.06f, Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Reissue Effective: 08/14/2017 | Reissue Posted: 08/14/2017

11.00.13f, Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Reissue Effective: 08/15/2017 | Reissue Posted: 08/15/2017

09.00.48f, Radioembolization for Primary and Metastatic Tumors of the Liver (AmeriHealth Administrators)
Reissue Effective: 08/15/2017 | Reissue Posted: 08/15/2017

07.00.02h, Intravenous Chelation Therapy
Reissue Effective: 08/15/2017 | Reissue Posted: 08/15/2017

07.00.10h, Photodynamic Therapy (PDT) using Porfimer Sodium (Photofrin®)
Reissue Effective: 08/15/2017 | Reissue Posted: 08/15/2017

07.03.10e, Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

07.05.08, Fecal Microbiota Transplantation (FMT)
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

11.07.02g, Sentinel Lymph Node Biopsy
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

11.04.01c, Islet Cell Transplantation
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

11.03.15h, Gastric Electrical Stimulation (Enterra™), Gastric Pacing
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

08.01.03c, Belatacept (Nulojix®)
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

11.08.19l, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

08.00.62g, Abatacept (Orencia®) for Injection for Intravenous Use
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

08.00.93e, C1 Esterase Inhibitors: Cinryze®, Berinert®, and Ruconest®
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

08.00.85f, Tocilizumab (Actemra®) for Intravenous Infusion
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

08.00.86a, Ecallantide (Kalbitor®)
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

08.00.49d, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

08.01.12b, Repository Corticotropin (H.P. Acthar® Gel Injection)
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

08.00.17g, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

05.00.26d, Home Prothrombin Time Monitoring
Reissue Effective: 08/16/2017 | Reissue Posted: 08/16/2017

05.00.42g, Patient Lifts
Reissue Effective: 08/25/2017 | Reissue Posted: 08/25/2017

05.00.25g, Cranial Remolding Orthoses (Helmets)
Reissue Effective: 08/25/2017 | Reissue Posted: 08/25/2017

05.00.30j, Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices
Reissue Effective: 08/25/2017 | Reissue Posted: 08/25/2017

05.00.67m, Wheelchair Options and Accessories
Reissue Effective: 08/25/2017 | Reissue Posted: 08/25/2017

07.08.01f, Non-Surgical Spinal Decompression Therapy
Reissue Effective: 08/25/2017 | Reissue Posted: 08/25/2017

05.00.58i, Home Oxygen Therapy
Reissue Effective: 08/25/2017 | Reissue Posted: 08/25/2017

07.08.03c, Medical and Surgical Treatment of Temporomandibular Joint Disorder
Reissue Effective: 08/25/2017 | Reissue Posted: 08/25/2017

11.14.02l, Trigger Point Injections
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.17d, Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.13g, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.11f, Arthroscopic Electrothermal Joint Repair
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.03e, Meniscal Allograft Transplantation
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.14e, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.23c, Surgical Treatment of Femoroacetabular Impingement
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.19k, Artificial Intervertebral Disc Insertion
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.22d, Spinal Decompression with Interspinous and Interlaminar Devices
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.24a, Manipulation Under Anesthesia
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.15.15f, Percutaneous Discectomy
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.15.22d, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.26a, Surgical Treatments of Athletic Pubalgia
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

11.14.29a, Spinal Discectomy
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

08.01.23c, Interleukin-5 Antagonist for Severe Eosinophilic Asthma (e.g., Nucala®, Cinqair®)
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

08.00.15d, Off-label Coverage for Prescription Drugs and/or Biologics
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

08.00.22m, Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

05.00.43f, Seat Lift Mechanisms
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

05.00.50k, Ostomy Supplies
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

05.00.55h, Wheelchair Cushions and Seating
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

05.00.42g, Patient Lifts
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017


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.
06.02.35n, Genetic Testing (AmeriHealth Administrators)
Effective: 08/01/2017 | Posted: 08/01/2017

06.02.52f, eviCore Lab Management Program (AmeriHealth)
Effective: 08/01/2017 | Posted: 08/01/2017

00.01.25am, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 08/21/2017 | Posted: 08/21/2017

00.03.07r, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 08/01/2017 | Posted: 08/21/2017