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News & Announcements1/1/2021 CPT & HCPCS Annual Code Update Coverage Determinations for Commercial Products1/4/2021
News & AnnouncementsTelemedicine Services for AmeriHealth Pennsylvania Members (Updated January 4, 2021)1/4/2021
NotificationsPatient Lifts05.00.42h1/15/2021 1:00 PM2/15/20211/15/2021Coverage and/or Reimbursement Position
NotificationsAnkle-Foot/Knee-Ankle-Foot Orthoses05.00.39p1/15/2021 2:00 PM2/15/20211/15/2021Coverage and/or Reimbursement Position;Medical Coding
New PoliciesArtificial Intervertebral Lumbar Disc Insertion11.15.3110/12/2020 2:00 PM1/10/20211/8/2021This is a New Policy.
New PoliciesOsteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound)05.00.811/10/20211/8/2021This is a New Policy.
Updated PoliciesCoagulation Factors 08.00.92ac9/28/2020 12:00 AM1/1/20211/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PolicieseviCore Lab Management (AmeriHealth)06.02.52s12/1/2020 1:00 AM1/1/20211/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesPemetrexed (Alimta®)08.00.87h1/4/20211/4/2021Medical Necessity Criteria
Updated PoliciesAdo-Trastuzumab Emtansine (Kadcyla®)08.01.11f1/4/20211/4/2021Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesReporting Requirements for Drugs and Biologics00.01.49d1/4/20211/4/2021Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesFacility Reporting of Observation Services00.01.19e1/4/20211/4/2021Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
Updated PoliciesGender Affirming Interventions11.09.02i1/4/20211/4/2021General Description, Guidelines, or Informational Update
Updated PoliciesHome Health Care Services02.01.01e1/4/20211/4/2021General Description, Guidelines, or Informational Update
Updated PoliciesPersonalized Vaccines (e.g. Provenge®)08.00.95e1/4/20211/4/2021Medical Necessity Criteria
Updated PoliciesAlpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)08.00.91e1/4/20211/4/2021Medical Necessity Criteria
Updated PoliciesCare Management and Care Planning Services00.01.59h1/4/20211/4/2021Medical Necessity Criteria
Updated PoliciesMusculoskeletal Services (AmeriHealth)00.01.66c10/12/2020 2:00 PM1/10/20211/8/2021Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesArtificial Intervertebral Cervical Disc Insertion (Amerihealth Administrators)11.14.19p10/12/2020 9:00 AM1/10/20211/8/2021Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesMeniscal Allograft Transplantation and Meniscal Implants (Amerihealth Administrators)11.14.03h1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesOsteochondral Allograft Transplantation (Amerihealth Administrators)11.14.12f1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesOsteochondral Autograft Transplantation (Amerihealth Administrators)11.14.09h1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesSurgical Treatment of Femoroacetabular Impingement (Amerihealth Administrators)11.14.23d1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesSpinal Discectomy (Amerihealth Administrators)11.14.29g1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesDenervation of the Spinal Nerves for Chronic Pain (Amerihealth Administrators)11.15.09o1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesPercutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty (Amerihealth Administrators)11.14.10s1/10/20211/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesSpinal Cord Ganglion and Dorsal Root Ganglion Stimulation (Amerihealth Administrators)11.15.01x1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesSpinal Fusion (Amerihealth Administrators)11.14.27e1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesSpinal Laminectomy (Amerihealth Administrators)11.14.28d1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesAutologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Amerihealth Administrators)11.14.06j1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesEpidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management (Amerihealth Administrators)11.15.23j1/10/20211/8/2021Coverage and/or Reimbursement Position
Updated PoliciesElectrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System (Amerihealth Administrators)05.00.09i1/10/20211/8/2021Coverage and/or Reimbursement Position
Coding UpdateInebilizumab-cdon (Uplizna)08.01.68a1/4/20211/4/2021
Coding UpdateGenetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (AmeriHealth Administrators)06.02.10r1/1/20211/4/2021
Coding UpdateDaratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)08.01.29h1/1/20211/4/2021
Coding UpdateLurbinectedin (Zepzelca)08.01.67a1/1/20211/4/2021
Coding UpdateImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13aa1/1/20211/4/2021
Coding UpdatePegfilgrastim (Neulasta®) and Related Biosimilars08.01.32d1/1/20211/4/2021
Coding UpdateBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus00.10.39n1/1/20211/4/2021
Coding UpdateMultiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services00.01.60e1/1/20211/4/2021
Coding UpdateRadiologic Guidance and/or Supervision and Interpretation of a Procedure00.10.36s1/1/20211/4/2021
Coding UpdateSTAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point of Service (POS) Products00.01.41c1/1/20211/4/2021
Coding UpdateSacituzumab govitecan-hziy (TrodelvyTM)08.01.60b1/1/20211/4/2021
Coding UpdateBelantamab mafodotin-blmf (Blenrep)08.01.70a1/1/20211/4/2021
Coding UpdateDirect Access to Obstetrics/Gynecology (OB/GYN) Services00.09.01h1/1/20211/4/2021
Coding UpdateReimbursement for Radiopharmaceutical Agents for Professional Providers09.00.32v1/1/20211/8/2021
Coding UpdateMultiple Surgery Payment Reduction11.00.10x1/1/20211/11/2021
Coding UpdateModifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service03.00.06t1/1/20211/11/2021
Coding UpdatePPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25ba1/1/20211/11/2021
Coding UpdateModifier 50: Bilateral Procedure03.00.05o1/1/20211/13/2021
Coding UpdateModifiers 26 (Professional Component) and TC (Technical Component)03.00.20l1/1/20211/13/2021
Coding UpdateServices Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers00.10.01ad1/1/20211/13/2021
Coding UpdateDiagnostic Radiology Services Included in Capitation00.03.02ab1/1/20211/15/2021
Coding UpdateModifier 66: Surgical Team00.10.17k1/1/20211/15/2021
Coding UpdateModifier 62: Two Surgeons00.10.11o1/1/20211/15/2021
Coding UpdateNew Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances00.01.55p1/1/20211/15/2021
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products00.03.07ab1/1/20211/15/2021