| 4/13/2026 | Expanded coverage for Arexvy, an adjuvanted respiratory syncytial virus (RSV) vaccine for Commercial Members (Retroactively effective 03/11/2026) | 0.1 | | The purpose of this document is to communicate expanded non-routine vaccine coverage for Arexvy (retroactively effective to March 11, 2026), an adjuvanted respiratory syncytial virus (RSV) vaccine for adult Commercial members aged 18 through 59 years who are at an increased risk for lower respiratory tract disease (LRTD) caused by RSV.
| Expanded coverage for Arexvy, an adjuvanted respiratory syncytial virus (RSV) vaccine for Commercial Members (Retroactively effective 03/11/2026) | 5d942702-1dea-453d-b81d-591986969fd1 |
| 4/1/2026 | 04/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 0.1 | |
The intent of this document is to communicate the Company's Commercial coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 04/01/2026, unless otherwise noted.
For more information related to these services, please refer to specific policies when applicable.
| 04/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | f885dacd-70c1-458a-ac49-eb345c4ed617 |
| 2/2/2026 | Coverage of Meningococcal Groups A, B, C, W, and Y Vaccine (PENMENVY) for Commercial Members (Retroactively Effective 02/14/2025) | 0.1 | | Retroactively effective to February 14, 2025, the purpose of this document is to communicate updated coverage and preventive coverage criteria for meningococcal Groups A, B, C, W, and Y vaccine (PENMENVY) for Commercial members.
| Coverage of Meningococcal Groups A, B, C, W, and Y Vaccine (PENMENVY) for Commercial Members (Retroactively Effective 02/14/2025) | b2d6d3ee-9f0b-424d-9625-4520c2493861 |
| 1/16/2026 | Coverage of Immune Globulin Intravenous (IVIG) and Subcutaneous (SCIG) for Measles Post-Exposure Prophylaxis in Commercial Members | 0.1 | | The purpose of this document is to communicate the Company's coverage position for immune globulin intravenous (IVIG) and subcutaneous (SCIG) for measles post-exposure prophylaxis in Commercial members who are severely immunocompromised or pregnant without evidence of immunity.
| Coverage of Immune Globulin Intravenous (IVIG) and Subcutaneous (SCIG) for Measles Post-Exposure Prophylaxis in Commercial Members | 43c17820-06a9-4a52-92aa-4c5ffca3f713 |
| 12/31/2025 | 01/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 0.1 | | The intent of this document is to communicate the Company's Commercial coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 01/01/2026, unless otherwise noted.
For more information related to these services, please refer to specific policies when applicable. | 01/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 700cb27f-7ea7-4bde-837c-9e87fd1b068c |
| 10/1/2025 | 10/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 0.1 | | The intent of this document is to communicate the Company's Commercial coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 10/01/2025, unless otherwise noted.
For more information related to these services, please refer to specific policies when applicable. | 10/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | e0476f25-8643-4748-8f94-1ee77be8e1fc |
| 9/23/2025 | Preventive Coverage of Clesrovimab (Enflonsia) for Commercial Members (Retroactively Effective 08/04/2025) | 0.1 | | Retroactively effective to August 4, 2025, the purpose of this
communication is to provide notice regarding the updated coverage and
preventive coverage for clesrovimab (Enflonsia), a respiratory syncytial
virus (RSV) immunization for Commercial members.
| Preventive Coverage of Clesrovimab (Enflonsia) for Commercial Members (Retroactively Effective 08/04/2025) | 06d03df1-d878-45f4-a3ee-9983ac0d1456 |
| 8/26/2025 | Preventive Coverage Expansion of Respiratory Syncytial Virus Vaccine for Commercial Members (Retroactively Effective June 12, 2025) | 0.1 | | The purpose of this communication is to provide notice of updates to coverage of respiratory syncytial virus vaccine (RSV) for the following: - Retroactively effective to June 12, 2025, the medically necessary coverage for non-routine use of respiratory syncytial virus vaccine (
 mRESVIA) was updated to include individuals 18 to 59 years of age who are at increased risk of severe RSV disease.
- Retroactively effective to June 25, 2025, the medically necessary coverage and preventive coverage criteria were updated to expand for the respiratory syncytial virus vaccine to cover adults 50 to 59 years of age who are at increased risk of severe RSV disease.
| Preventive Coverage Expansion of Respiratory Syncytial Virus Vaccine for Commercial Members (Retroactively Effective June 12, 2025) | d2d775e8-4541-4557-a073-aff1c8e039f5 |
| 7/1/2025 | 07/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 0.1 | | The intent of this document is to communicate the Company's Commercial coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 07/01/2025, unless otherwise noted. For more information related to these services, please refer to specific policies when applicable. | 07/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 6e309a68-277d-4cf5-aa25-2d64dd46a1d0 |
| 4/22/2025 | Clarification on the coverage of Meningococcal (Groups A, C, W, and Y) conjugate vaccines for Commercial Members (Retroactively Effective to November 18, 2024) | 0.1 | | The purpose of this communication is to clarify the Company's coverage position for our Commercial members regarding meningococcal (Groups A, C, W, and Y) conjugate vaccines, which is retroactively effective to November 18, 2024.
| Clarification on the coverage of Meningococcal (Groups A, C, W, and Y) conjugate vaccines for Commercial Members (Retroactively Effective to November 18, 2024) | 42096814-dee4-4cbf-aa0f-56097d96a4ca |
| 4/1/2025 | 04/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 0.1 | | The intent of this document is to communicate Commercial Product coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 04/01/2025, unless otherwise noted.
For more information related to these services, please refer to specific policies when applicable. | 04/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | fef3dc54-435b-47ae-984b-492239e22b4a |
| 12/23/2024 | Coverage Expansion of Respiratory Syncytial Virus Vaccine (Abrysvo) for Commercial Members (Retroactively Effective October 22, 2024) | 0.1 | | The
purpose of this communication is to provide notice regarding the updated
coverage criteria for respiratory syncytial virus vaccine (Abrysvo)
retroactively effective to October 22, 2024 for Commercial members.
| Coverage Expansion of Respiratory Syncytial Virus Vaccine (Abrysvo) for Commercial Members (Retroactively Effective October 22, 2024) | c802add7-3104-4884-bf48-642856795c52 |
| 7/3/2024 | Pemivibart (Pemgarda) for Pre-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) for Commercial Members | 0.1 | | The purpose of this document is to communicate the Company's coverage position for pemivibart (Pemgarda, Invivyd, Inc.) for pre-exposure prophylaxis for Coronavirus disease 2019 (COVID-19) for Commercial members. Coverage for pre-exposure prophylaxis for Coronavirus disease 2019 (COVID-19) for Commercial members is retroactively effective to March 22, 2024.
| Pemivibart (Pemgarda) for Pre-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) for Commercial Members | 0cbeb616-d203-4bd1-8649-1e54cbc2a7a3 |
| 5/12/2023 | Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) For AmeriHealth Pennsylvania Members (Updated May 12, 2023) | 0.1 | | The purpose of this communication is to provide advance notice regarding information and procedure codes related to testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for AmeriHealth Pennsylvania members. Additionally, this Company document identifies when coverage is provided for clinical purposes, and the noncovered instances such as public health surveillance and screening.
| Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) For AmeriHealth Pennsylvania Members (Updated May 12, 2023) | 8e6011b3-4c59-4ed2-920c-c5d19a50e6d8 |
| 5/12/2023 | Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for AmeriHealth New Jersey Members (Updated May 12, 2023) | 0.1 | | The purpose of this communication is to provide advance notice regarding information and procedure codes related to testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for AmeriHealth New Jersey members. Additionally, this Company document identifies when coverage is provided for clinical purposes, and the noncovered instances such as public health surveillance and screening.
| Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for AmeriHealth New Jersey Members (Updated May 12, 2023) | d4d08b64-c6d0-4f16-8a95-0038faf1febb |
