| 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 |
| 10/8/2024 | 10/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products (Updated October 8, 2024) | 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 10/01/2024, unless otherwise noted.
For more information related to these services, please refer to specific policies when applicable.
| 10/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products (Updated October 8, 2024) | 6091cb73-1496-44d9-9ca0-964010ca03ce |
| 8/28/2024 | New Preventive Coverage of 21-valent Pneumococcal Vaccine and Updated Preventive Coverage for Respiratory Syncytial Virus Vaccines for Commercial Members (Retroactively effective to June 7, 2024) | 0.1 | | The purpose
of this communication is to provide notice regarding the updated coverage
criteria for respiratory syncytial virus vaccines and new coverage
criteria for 21-valent pneumococcal vaccine for Commercial members. Services covered are retroactively effective to June 7, 2024.
| New Preventive Coverage of 21-valent Pneumococcal Vaccine and Updated Preventive Coverage for Respiratory Syncytial Virus Vaccines for Commercial Members (Retroactively effective to June 7, 2024) | ba53741f-ab6f-48dc-b883-fed036ed06d5 |
| 8/5/2024 | Coverage of Cantharidin (Ycanth) Topical Solution for Commercial Products (Retroactively Effective to 04/01/2024) | 0.1 | | The purpose of this document is to communicate that the Company has revised its coverage position for cantharidin (Ycanth) topical solution.
The coverage position for cantharidin (Ycanth), represented by HCPCS code J7354, has been revised from non-covered to medically necessary. This medically necessary coverage position is retroactively effective for dates of service beginning 04/01/2024.
| Coverage of Cantharidin (Ycanth) Topical Solution for Commercial Products (Retroactively Effective to 04/01/2024) | bf9fcd71-131c-43bb-b610-7e1a5f51b12c |
| 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 |
| 7/1/2024 | Coverage for Low Frequency Ultrasound Treatment for Wound Management for Commercial Members | 1 | | The purpose of this communication is to provide advance notice regarding the change of coverage determination for low frequency ultrasound for wound management for our Commercial Members. This change will become effective on October 1, 2024. Low frequency ultrasound for wound management, represented by CPT code 97610, will be added to Policy #12.01.01bn: Experimental/Investigational Services, effective October 1, 2024.
| Coverage for Low Frequency Ultrasound Treatment for Wound Management for Commercial Members | 9da2d51e-6484-4a0b-b60b-db282f60cce8 |
| 4/1/2024 | 4/01/2024 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 04/01/2024, unless otherwise noted. For more information related to these services, please refer to specific policies when applicable.
| 4/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 71b43f8b-3df5-4827-9b1b-2791fff88446 |
| 12/29/2023 | 1/01/2024 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 01/01/2024, unless otherwise noted. For more information related to these services, please refer to specific policies when applicable.
| 1/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | ba956e39-8e7b-45c6-aa3d-998b0e502521 |
| 12/15/2023 | Coverage of Meningococcal ABCWY vaccine and Smallpox and Mpox Vaccine for AmeriHealth Commercial Members (Retroactively Effective to October 26, 2023) | 0.1 | | Retroactively effective to October 26, 2023, the
purpose of this communication is to provide notice regarding the preventive coverage
criteria for meningococcal groups
A, B, C, W, and Y vaccine (Penbraya) and smallpox and mpox vaccine, live,
non-replicating (Jynneos) vaccine for AmeriHealth Commercial members.
| Coverage of Meningococcal ABCWY vaccine and Smallpox and Mpox Vaccine for AmeriHealth Commercial Members (Retroactively Effective to October 26, 2023) | 662c4c0d-2185-42ab-813c-728259b069f6 |
| 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 |
| 1/4/2021 | 1/1/2021 CPT & HCPCS Annual Code Update Coverage Determinations for Commercial Products | 0 | | The intent of this document is to communicate Commercial Product coverage determinations for services identified through the Annual Code Update process.
| 1/1/2021 CPT & HCPCS Annual Code Update Coverage Determinations for Commercial Products | e9ec2c0c-fb3f-4dc8-ba77-76f1d77bff75 |
