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4/1/2025
04/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products
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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 Productsfef3dc54-435b-47ae-984b-492239e22b4a
12/23/2024
Coverage Expansion of Respiratory Syncytial Virus Vaccine (Abrysvo) for Commercial Members (Retroactively Effective October 22, 2024)
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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)
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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)
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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)
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​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
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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 Members0cbeb616-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 Members9da2d51e-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 Products71b43f8b-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 Productsba956e39-8e7b-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)
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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)
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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 nonco​vered 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)
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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 nonco​vered 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
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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 Productse9ec2c0c-fb3f-4dc8-ba77-76f1d77bff75