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News & Announcements1/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products1/3/2025
NotificationsEye Prostheses and Scleral Cover Shell05.00.831/24/2025 10:00 AM2/24/20251/24/2025This is a New Policy.
NotificationsBariatric Surgery11.03.02v1/24/2025 11:00 AM2/24/20251/24/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
New PoliciesMedical Nutrition Therapy (MNT)/Nutrition Counseling10.00.0412/2/2024 2:00 PM1/1/20251/1/2025This is a New Policy.
New PoliciesDrugs, Biologics, or Gene Therapies with an Accelerated Approval08.02.3512/2/2024 2:00 PM1/1/20251/2/2025This is a New Policy.
New PoliciesIntravenous (IV) Iron Preparations08.02.291/1/20251/15/2025This is a New Policy.1/15/2025
New PoliciesIntravenous (IV) Iron Preparations08.02.291/1/20251/15/2025This is a New Policy.
New PoliciesDirect Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis11.03.1612/17/2024 12:00 PM1/20/20251/20/2025This is a New Policy.
New PoliciesProtein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer06.02.5312/23/2024 10:00 AM1/27/20251/27/2025This is a New Policy.
Updated PoliciesMonoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer Disease08.01.93e12/2/2024 3:00 PM1/1/20251/1/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesFetal Surgery11.00.03m12/3/2024 3:00 PM1/1/20251/1/2025Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesPreventive Care Services00.06.02at1/1/20251/1/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
Updated PoliciesExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)08.01.34d12/2/2024 3:00 PM1/1/20251/1/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria
Updated PolicieseviCore Lab Management (AmeriHealth)06.02.52ai12/2/2024 5:00 PM1/1/20251/1/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesEndovascular Stent Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions11.02.17i1/1/20251/2/2025Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21q1/1/20251/2/2025Medical Coding
Updated PoliciesOvarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome11.06.07e1/1/20251/2/2025General Description, Guidelines, or Informational Update
Updated PoliciesTofersen (Qalsody®)08.02.06b12/2/2024 9:00 AM1/1/20251/2/2025Coverage and/or Reimbursement Position
Updated PoliciesAtezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)08.01.69d1/1/20251/2/2025Medical Necessity Criteria
Updated PoliciesAsparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)08.01.35i1/1/20251/2/2025Medical Necessity Criteria
Updated PoliciesTotal Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)08.00.17k12/3/2024 9:00 AM1/1/20251/2/2025Medical Necessity Criteria
Updated PoliciesSkilled Nursing Facility (SNF): Skilled and Subacute Levels of Care02.03.00a1/6/20251/6/2025General Description, Guidelines, or Informational Update
Updated PoliciesTeprotumumab-trbw (Tepezza®)08.00.41b1/6/20251/6/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesOmalizumab (Xolair®)08.00.55l1/6/20251/6/2025Coverage and/or Reimbursement Position
Updated PoliciesVagus Nerve Stimulation (VNS)11.15.16w1/6/20251/6/2025Medical Coding
Updated PoliciesHome Health Care Services02.01.01g1/6/20251/6/2025General Description, Guidelines, or Informational Update
Updated PoliciesCervical Traction Devices for In-home Use05.00.61h1/6/20251/6/2025General Description, Guidelines, or Informational Update
Updated PoliciesHigh-Frequency Chest Wall Oscillation Devices05.00.14q10/17/20241/6/2025Medical Coding
Updated PoliciesStem-Cell Therapy/Platelet-Rich Plasma for Orthopedic Applications and ​Platelet-Rich Plasma/Platelet-Derived Growth Factor for Wound Healing and Other Miscellaneous Non-Orthopedic Conditions07.07.09j1/6/20251/6/2025Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
Updated PoliciesIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors08.00.74x10/8/2024 9:00 AM1/1/20251/6/2025Medical Necessity Criteria1/6/2025
Updated PoliciesVagus Nerve Stimulation (VNS)11.15.16w1/6/20251/7/2025Medical Coding1/7/2025
Updated PoliciesVagus Nerve Stimulation (VNS)11.15.16w1/6/20251/10/2025Medical Coding
Updated PoliciesTreatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence11.02.01t12/13/2024 11:00 AM1/13/20251/13/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesModifier 50: Bilateral Procedure03.00.05z12/13/2024 2:00 PM1/13/20251/13/2025Medical Coding
Updated PoliciesModifier 62: Two Surgeons00.10.11ab12/13/2024 2:00 PM1/13/20251/13/2025Medical Coding
Updated PoliciesLuspatercept–aamt (Reblozyl®)08.00.10d10/22/2024 11:00 AM1/17/20251/17/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update1/17/2025
Updated PoliciesLutathera® (Lutetium Lu 177 Dotatate) (AmeriHealth Administrators)08.01.57a1/27/20251/27/2025Medical Necessity Criteria
Reissue PoliciesTherapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)08.01.36e7/1/202010/2/20241/3/2025
Reissue PoliciesPeroral Endoscopic Myotomy (POEM) Procedures11.03.172/19/20249/18/20241/3/2025
Reissue PoliciesMeasurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders07.11.02f3/26/20181/22/20251/22/2025
Reissue PoliciesCosmetic Procedures12.01.03b7/1/20232/20/20251/22/2025
Reissue PoliciesCranial Remolding Orthoses (Helmets)05.00.25j10/1/20231/22/20251/22/2025
Reissue PoliciesNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease06.02.56i7/1/20241/22/20251/22/2025
Reissue PoliciesInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®)08.01.23i10/4/20211/22/20251/22/2025
Coding UpdateImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13ak1/1/20251/2/2025
Coding UpdateFilgrastim (Neupogen®) and Related Biosimilars, and tbo-filgrastim (Granix®)08.01.73g1/1/20251/2/2025
Coding UpdateSurgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)11.17.06s1/1/20251/3/2025
Coding UpdateGenetic Testing (AmeriHealth Administrators)06.02.35ao7/1/20241/6/2025
Coding UpdateNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease06.02.56i7/1/20241/6/2025
Coding UpdatePrescription Digital Therapeutics and Mobile-Based Health Management Applications12.00.05d1/1/20251/6/2025
Coding UpdatePercutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound  (AmeriHealth)11.02.27j1/1/20251/14/20251/14/2025
Coding UpdatePercutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound  (AmeriHealth)11.02.27j1/1/20251/15/2025
Coding UpdateAcupuncture12.00.01i1/1/20251/15/2025
Coding UpdateCare Management and Care Planning Services00.01.59o1/1/20251/20/2025
Coding UpdateAlways Bundled Procedure Codes00.01.52x1/1/20251/20/2025
Coding UpdateMechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures05.00.70d1/1/20251/23/2025
Coding UpdateRhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty11.08.13h1/1/20251/27/2025
Coding UpdateBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus00.10.39q1/1/20251/27/2025
Coding UpdateDurable Medical Equipment (DME) and Consumable Medical Supplies05.00.21af1/1/20251/27/2025
Coding UpdateDiagnostic Radiology Services Included in Capitation00.03.02af1/1/20251/27/2025
Coding UpdateNew Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances00.01.55z1/1/20251/30/2025
Coding UpdatePreimplantation Genetic Testing (AmeriHealth Administrators)06.02.24k1/1/20251/31/2025
Coding UpdatePPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25br1/1/20251/31/2025
Coding UpdateGenetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)06.02.06s1/1/20251/31/2025
Coding UpdateNoninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (AmeriHealth Administrators)06.02.47f1/1/20251/31/2025
Coding UpdateFidanacogene elaparvovec-dzkt (Beqvez™)08.02.25a1/1/20251/31/2025
Coding UpdateAssays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators)06.02.27p1/1/20251/31/2025