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.
05.00.78, Transtympanic Micropressure Device as a Treatment of Meniere Disease
Notification: 09/01/2016 | Effective: 10/01/2016 | Posted: 09/01/2016
Type of policy change: This is a new policy.

08.00.73h, Bortezomib (Velcade®)
Notification: 09/01/2016 | Effective: 10/01/2016 | Posted: 09/01/2016
Type of policy change: Medical Necessity Criteria

07.10.06d, Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation
Notification: 09/02/2016 | Effective: 12/01/2016 | Posted: 09/02/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.00.03n, Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy
Notification: 09/02/2016 | Effective: 12/01/2016 | Posted: 09/02/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.00.14f, Low-level Laser Therapy (LLLT)
Notification: 09/14/2016 | Effective: 10/14/2016 | Posted: 09/14/2016

07.03.05s, Sleep Disorder Testing and Positive Airway Pressure Therapy
Notification: 09/14/2016 | Effective: 10/14/2016 | Posted: 09/14/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.31, Fulvestrant (Faslodex®)
Notification: 09/30/2016 | Effective: 01/01/2017 | Posted: 09/30/2016
Type of policy change: This is a new policy.

05.00.61f, Cervical Traction Devices for In-home Use
Notification: 09/30/2016 | Effective: 11/01/2016 | Posted: 09/30/2016
Type of policy change: Coverage and/or Reimbursement Position

09.00.56c, Radiation Therapy Services (AmeriHealth)
Notification: 09/30/2016 (revised 12/08/2016) | Effective: 01/01/2017 | Posted: 09/30/2016
Type of policy change: Medical Coding

08.01.32, Pegfilgrastim (Neulasta®)
Notification: 09/30/2016 (revised 11/10/2016) | Effective: 01/01/2017 | Posted: 09/30/2016
Type of policy change: This is a new policy.

11.14.24a, Manipulation Under Anesthesia
Notification: 09/30/2016 | Effective: 01/01/2017 | Posted: 09/30/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.00.13f, Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Notification: 09/30/2016 | Effective: 01/01/2017 | Posted: 09/30/2016
Type of policy change: Medical Coding

12.01.01ai, Experimental/Investigational Services
Notification: 09/30/2016 (revised 12/22/2016) | Effective: 01/01/2017 | Posted: 09/30/2016
Type of policy change: Medical Coding


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.
03.00.33, Modifier 53: Discontinued Procedure
Notification: 07/01/2016 | Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: This is a new policy.

05.00.78, Transtympanic Micropressure Device as a Treatment of Meniere Disease
Notification: 09/01/2016 | Effective: 10/01/2016 | Posted: 09/30/2016
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.
11.05.11c, Implantation of Intrastromal Corneal Ring Segments (ICRS)
Effective: 09/07/2016 | Posted: 09/07/2016
Type of policy change: General Description, Guidelines, or Informational Update

11.02.01l, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Effective: 09/07/2016 | Posted: 09/07/2016
Type of policy change: Medical Coding

11.05.07d, Surgical Correction of Strabismus
Effective: 09/07/2016 | Posted: 09/07/2016
Type of policy change: General Description, Guidelines, or Informational Update

00.05.01e, Guidelines for Well Mother/Well Baby Visits Under the Mother's Option Program
Effective: 09/09/2016 | Posted: 09/09/2016
Type of policy change: Medical Coding

11.07.01o, Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)
Effective: 09/09/2016 | Posted: 09/09/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

08.01.25a, Ramucirumab (Cyramza®)
Effective: 09/21/2016 | Posted: 09/21/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

08.00.17g, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)
Effective: 09/21/2016 | Posted: 09/21/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.15.03h, Insertion of Implantable Infusion Pumps
Notification: 08/24/2016 | Effective: 09/23/2016 | Posted: 09/23/2016
Type of policy change: Medical Coding

12.01.01ah, Experimental/Investigational Services
Notification: 07/01/2016 | Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Medical Coding

05.00.11f, Therapeutic Shoes and Orthopedic Shoes
Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Medical Coding

05.00.05i, Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

11.01.02l, Cochlear Implant
Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.02.05j, External Counterpulsation (ECP)
Effective: 09/30/2016 | Posted: 09/30/2016
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

11.06.04j, Uterine Artery Embolization
Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.02.12g, Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery
Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

11.01.06c, Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.01.52d, Always Bundled Procedure Codes
Notification: 07/01/2016 | Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Medical Coding

05.00.35d, Foot Orthotics and Other Podiatric Appliances
Notification: 08/24/2016 | Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

08.00.73h, Bortezomib (Velcade®)
Notification: 09/01/2016 | Effective: 10/01/2016 | Posted: 09/30/2016
Type of policy change: Medical Necessity Criteria


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
05.00.77, Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia
Reissue Effective: 08/31/2016 | Reissue Posted: 09/01/2016

11.00.06f, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults
Reissue Effective: 08/31/2016 | Reissue Posted: 09/01/2016

10.04.01k, Pulmonary Rehabilitation
Reissue Effective: 08/31/2016 | Reissue Posted: 09/01/2016

11.16.03f, Lung Volume Reduction Surgery
Reissue Effective: 08/31/2016 | Reissue Posted: 09/01/2016

09.00.56b, Radiation Therapy Services (AmeriHealth)
Reissue Effective: 09/02/2016 | Reissue Posted: 09/02/2016

05.00.54g, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
Reissue Effective: 09/14/2016 | Reissue Posted: 09/15/2016

02.01.01d, Home Health Care Services
Reissue Effective: 09/14/2016 | Reissue Posted: 09/15/2016

05.00.54g, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
Reissue Effective: 09/15/2016 | Reissue Posted: 09/15/2016

07.02.21, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Reissue Effective: 09/14/2016 | Reissue Posted: 09/15/2016

08.01.00c, Hydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies
Reissue Effective: 09/28/2016 | Reissue Posted: 09/28/2016

05.00.45i, Repair or Replacement of an External Prosthetic Device
Reissue Effective: 09/28/2016 | Reissue Posted: 09/28/2016

08.00.99b, Belimumab (Benlysta®)
Reissue Effective: 09/28/2016 | Reissue Posted: 09/28/2016


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.
05.00.29i, Automatic External and Wearable Cardioverter Defibrillators
Effective: 10/01/2016 | Posted: 09/30/2016

05.00.25g, Cranial Remolding Orthoses (Helmets)
Effective: 10/01/2016 | Posted: 09/30/2016

00.01.44f, Never Events and Preventable Adverse Events
Effective: 10/01/2016 | Posted: 09/30/2016

05.00.24m, Interstitial Continuous Glucose Monitoring Systems (CGMSs) and Artificial Pancreas Device Systems (APDS)
Effective: 10/01/2016 | Posted: 09/30/2016

07.00.01g, Biofeedback Therapy
Effective: 10/01/2016 | Posted: 09/30/2016

07.02.09e, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Effective: 10/01/2016 | Posted: 09/30/2016

07.03.18k, Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Effective: 10/01/2016 | Posted: 09/30/2016

07.05.02m, Wireless Capsule Endoscopy (WCE) as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon
Effective: 10/01/2016 | Posted: 09/30/2016

07.03.21h, Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
Effective: 10/01/2016 | Posted: 09/30/2016

07.07.01k, Routine Foot Care For Certain Medical Conditions
Effective: 10/01/2016 | Posted: 09/30/2016

08.00.74i, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (eg, ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], aflibercept [Eylea®])
Effective: 10/01/2016 | Posted: 09/30/2016

08.00.22m, Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
Effective: 10/01/2016 | Posted: 09/30/2016

07.10.06c, Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation
Effective: 10/01/2016 | Posted: 09/30/2016

07.03.09l, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Effective: 10/01/2016 | Posted: 09/30/2016

07.13.11f, Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
Effective: 10/01/2016 | Posted: 09/30/2016

08.00.92q, Coagulation Factors
Effective: 10/01/2016 | Posted: 09/30/2016

08.00.50o, Rituximab (Rituxan®)
Effective: 10/01/2016 | Posted: 09/30/2016

07.13.05i, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Effective: 10/01/2016 | Posted: 09/30/2016

07.10.05g, Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
Effective: 10/01/2016 | Posted: 09/30/2016

10.01.01l, Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Programs
Effective: 10/01/2016 | Posted: 09/30/2016

12.05.01h, Outpatient Diabetes Education and Self-Management Training
Effective: 10/01/2016 | Posted: 09/30/2016

11.15.01q, Spinal Cord Stimulation (Dorsal Column Stimulation)
Effective: 10/01/2016 | Posted: 09/30/2016

08.00.81e, Bendamustine Hydrochloride (Treanda®)
Effective: 10/01/2016 | Posted: 09/30/2016

11.11.01i, Evaluation and Treatment of Erectile Dysfunction (ED)
Effective: 10/01/2016 | Posted: 09/30/2016

11.02.10k, Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Effective: 10/01/2016 | Posted: 09/30/2016

11.08.14i, Removal of Breast Implants
Effective: 10/01/2016 | Posted: 09/30/2016

08.01.10c, Octreotide acetate (Sandostatin® LAR Depot)
Effective: 10/01/2016 | Posted: 09/30/2016

11.17.06k, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Effective: 10/01/2016 | Posted: 09/30/2016

11.11.06h, Saturation Needle Biopsy of the Prostate
Effective: 10/01/2016 | Posted: 09/30/2016

08.01.13b, Brentuximab Vedotin (Adcetris®)
Effective: 10/01/2016 | Posted: 09/30/2016

11.15.09h, Denervation of the Spinal Nerves for Chronic Pain
Effective: 10/01/2016 | Posted: 09/30/2016

11.15.20m, Deep Brain Stimulation (DBS)
Effective: 10/01/2016 | Posted: 09/30/2016

09.00.46r, High-Technology Radiology Services
Effective: 10/01/2016 | Posted: 09/30/2016

06.02.24j, Preimplantation Genetic Testing (AmeriHealth Administrators)
Effective: 10/01/2016 | Posted: 09/30/2016

11.05.16d, Aqueous Shunts, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
Effective: 10/01/2016 | Posted: 09/30/2016

00.06.02r, Preventive Care Services
Effective: 10/01/2016 | Posted: 09/30/2016