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.
00.10.15c, Cast and Splint Applications and Associated Supplies Provided in the Office Setting
Notification: 09/01/2017 | Effective: 12/01/2017 | Posted: 09/01/2017
Type of policy change: Coverage and/or Reimbursement Position

07.00.01h, Biofeedback Therapy
Notification: 09/06/2017 | Effective: 10/06/2017 | Posted: 09/06/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.06.02u, Preventive Care Services (AmeriHealth)
Notification: 09/28/2017, Revised 12/18.2017 | Effective: 01/01/2018 | Posted: 09/28/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.01.08c, Coverage of Prescription Oral Anticancer Drugs and/or Biologics as Provided Under the Company's Medical Benefit
Notification: 09/29/2017 | Effective: 01/01/2018 | Posted: 09/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

08.00.78w, Self-Administered Drugs
Notification: 09/29/2017 | Effective: 10/30/2017 | Posted: 09/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.01.40, Lanreotide (Somatuline® Depot)
Notification: 09/29/2017 | Effective: 01/01/2018 | Posted: 09/29/2017
Type of policy change: This is a new policy.

08.00.74l, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (e.g., ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], aflibercept [Eylea®], and related biosimilars)
Notification: 09/29/2017 | Effective: 10/30/2017 | Posted: 09/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.92s, Coagulation Factors
Notification: 09/29/2017 | Effective: 10/30/2017 | Posted: 09/29/2017
Type of policy change: Medical Necessity Criteria; 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.
08.01.39, Cerliponase alfa (Brineura™)
Notification: 08/09/2017 | Effective: 09/08/2017 | Posted: 09/08/2017
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.
09.00.56d, Radiation Therapy Services (AmeriHealth)
Notification: 06/07/2017 | Effective: 09/01/2017 | Posted: 09/01/2017
Type of policy change: General Description, Guidelines, or Informational Update

08.01.20f, Programmed Death Receptor-1 (PD-1) Antagonists (e.g., Keytruda®, Opdivo®) and Programmed Death-Ligand 1 (PD-L1) Antagonists (e.g., Tecentriq®, Bavencio®, Imfinzi™)
Effective: 09/06/2017 | Posted: 09/06/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.01f, Ipilimumab (Yervoy®)
Effective: 09/06/2017 | Posted: 09/06/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.29c, Daratumumab (Darzalex™)
Effective: 09/06/2017 | Posted: 09/06/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.02.25f, Transcatheter Cardiac Valve Procedures
Effective: 09/15/2017 | Posted: 09/15/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

05.00.56i, Hospital Beds and Accessories
Effective: 09/20/2017 | Posted: 09/20/2017
Type of policy change: General Description, Guidelines, or Informational Update

08.01.10d, Octreotide acetate (Sandostatin® LAR Depot)
Effective: 09/20/2017 | Posted: 09/20/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.66j, Bevacizumab (Avastin®) and related biosimilars
Effective: 09/20/2017 | Posted: 09/20/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

09.00.46s NJ, High-Technology Radiology Services (AmeriHealth New Jersey)
Effective: 09/22/2017 | Posted: 09/22/2017
Type of policy change: General Description, Guidelines, or Informational Update

09.00.46s PA, High-Technology Radiology Services (AmeriHealth Pennsylvania)
Effective: 09/22/2017 | Posted: 09/22/2017
Type of policy change: General Description, Guidelines, or Informational Update

11.01.07d, Cataract Surgery
Effective: 09/27/2017 | Posted: 09/27/2017
Type of policy change: Medical Necessity Criteria

11.08.17g, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Notification: 06/29/2017 | Effective: 09/27/2017 | Posted: 09/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.13s, Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Notification: 06/30/2017 | Effective: 10/01/2017 | Posted: 09/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
11.11.01i, Evaluation and Treatment of Erectile Dysfunction (ED)
Reissue Effective: 09/13/2017 | Reissue Posted: 09/14/2017

07.12.01e, Pelvic Floor Stimulation as a Treatment of Incontinence
Reissue Effective: 09/27/2017 | Reissue Posted: 09/28/2017

08.00.95d, Personalized Vaccines (e.g. Provenge®)
Reissue Effective: 09/28/2017 | Reissue Posted: 09/28/2017

11.11.06h, Saturation Needle Biopsy of the Prostate
Reissue Effective: 09/27/2017 | Reissue Posted: 09/28/2017


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.
00.01.44g, Never Events and Preventable Adverse Events
Effective: 10/01/2017 | Posted: 09/29/2017

00.01.44g, Never Events and Preventable Adverse Events
Effective: 10/01/2017 | Posted: 09/29/2017

07.05.08a, Fecal Microbiota Transplantation (FMT)
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.35e, Foot Orthotics and Other Podiatric Appliances
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.74b, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Effective: 10/01/2017 | Posted: 09/29/2017

00.03.07s, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.14h, High-Frequency Chest Wall Oscillation Devices
Effective: 10/01/2017 | Posted: 09/29/2017

08.01.38a, Ocrelizumab (Ocrevus™)
Effective: 10/01/2017 | Posted: 09/29/2017

09.00.36j, First-Trimester Prenatal Screening for Fetal Aneuploidy Using Fetal Ultrasound Markers
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.05k, Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
Effective: 10/01/2017 | Posted: 09/29/2017

07.07.02j, Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Effective: 10/01/2017 | Posted: 09/29/2017

08.00.74k, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (eg, ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], aflibercept [Eylea®])
Effective: 10/01/2017 | Posted: 09/29/2017

11.02.12h, Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery
Effective: 10/01/2017 | Posted: 09/29/2017

07.13.05j, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.24o, Interstitial Continuous Glucose Monitoring Systems (CGMSs)
Effective: 10/01/2017 | Posted: 09/29/2017

07.03.09m, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Effective: 10/01/2017 | Posted: 09/29/2017

12.01.01al, Experimental/Investigational Services
Effective: 10/01/2017 | Posted: 09/29/2017

07.03.23a, Autonomic Nervous System Testing
Effective: 10/01/2017 | Posted: 09/29/2017

12.05.01i, Outpatient Diabetes Education and Self-Management Training
Effective: 10/01/2017 | Posted: 09/29/2017

11.08.06i, Panniculectomy, Abdominoplasty, and Other Excisions of Redundant Skin
Effective: 10/01/2017 | Posted: 09/29/2017

11.08.19m, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Effective: 10/01/2017 | Posted: 09/29/2017

07.03.21i, Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.29j, Automatic External and Wearable Cardioverter Defibrillators
Effective: 10/01/2017 | Posted: 09/29/2017

08.00.25j, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.01l, Pneumatic Compression Therapy Devices
Effective: 10/01/2017 | Posted: 09/29/2017

07.07.01l, Routine Foot Care For Certain Medical Conditions
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.11g, Therapeutic Shoes and Orthopedic Shoes
Effective: 10/01/2017 | Posted: 09/29/2017

10.03.01h, Physical Medicine, Rehabilitation, and Habilitation Services
Effective: 10/01/2017 | Posted: 09/29/2017

11.02.01n, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Effective: 10/01/2017 | Posted: 09/29/2017

10.01.01n, Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Programs
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.26e, Home Prothrombin Time Monitoring
Effective: 10/01/2017 | Posted: 09/29/2017

07.13.06j, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Effective: 10/01/2017 | Posted: 09/29/2017

10.02.02h, Chiropractic Spinal and Extraspinal Manipulation Therapy
Effective: 10/01/2017 | Posted: 09/29/2017

05.00.30k, Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices (AmeriHealth Adminstrators)
Effective: 10/01/2017 | Posted: 09/29/2017

07.10.05j, Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
Effective: 10/01/2017 | Posted: 09/29/2017

07.03.18l, Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Effective: 10/01/2017 | Posted: 09/29/2017

00.10.01x, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Effective: 10/01/2017 | Posted: 09/29/2017

11.03.02q, Bariatric Surgery
Effective: 10/01/2017 | Posted: 09/29/2017