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News & AnnouncementsCoverage of Immune Globulin Intravenous (IVIG) and Subcutaneous (SCIG) for Measles Post-Exposure Prophylaxis in Commercial Members1/16/2026
New PoliciesNipocalimab-aahu (Imaavy)08.02.431/1/20261/2/2026This is a New Policy.
New PoliciesRemote Electrical Neuromodulation for Migraines05.00.861/1/20261/2/2026This is a New Policy.
New PoliciesLeadless Pacemakers05.00.851/1/20261/5/2026This is a New Policy.
Updated PoliciesTelemedicine Services00.10.41q12/1/2025 10:00 AM1/1/20261/2/2026Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesUstekinumab for Intravenous Infusion08.00.82p1/1/20261/2/2026Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesTrastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)08.00.33v1/1/20261/2/2026Coverage and/or Reimbursement Position
Updated PoliciesSpeech Therapy10.06.01o1/1/20261/2/2026Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesPreventive Care Services00.06.02ax10/3/2025 11:00 AM1/1/20261/2/2026Medical Necessity Criteria;Medical Coding
Updated PoliciesEfbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars08.01.32o1/1/20261/2/2026Coverage and/or Reimbursement Position;Medical Necessity Criteria
Updated PoliciesEculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®) for intravenous administration08.00.84m1/1/20261/2/2026Medical Necessity Criteria
Updated PoliciesEfgartigimod alfa - fcab (Vyvgart) 08.01.84e1/1/20261/2/2026Medical Necessity Criteria
Updated PoliciesCoagulation Factors08.00.92ak1/1/20261/2/2026Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)08.00.50af1/1/20261/2/2026Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13am1/1/20261/2/2026Coverage and/or Reimbursement Position;Medical Coding;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) Inhibitors08.00.74ab1/1/20261/2/2026Medical Necessity Criteria
Updated PoliciesRadiation Therapy Services (AmeriHealth)09.00.56v1/1/20261/5/2026Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)07.13.06q10/1/20251/5/2026Medical Coding
Updated PoliciesPeroral Endoscopic Myotomy (POEM) Procedures11.03.17a1/5/20261/5/2026Medical Coding
Updated PoliciesMusculoskeletal Services (AmeriHealth)00.01.66q11/17/20251/6/2026Medical Necessity Criteria
Updated PoliciesDurable Medical Equipment (DME) and Consumable Medical Supplies [AmeriHealth New Jersey]05.00.21ai10/10/2025 10:00 AM1/10/20261/9/2026Coverage and/or Reimbursement Position
Updated PoliciesNot Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests00.01.24n1/12/20261/12/2026Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13am1/1/20261/13/2026Coverage and/or Reimbursement Position;Medical Coding;General Description, Guidelines, or Informational Update1/13/2026
Updated PoliciesImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13am1/1/20261/13/2026Coverage and/or Reimbursement Position;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesPembrolizumab (Keytruda®)08.01.63f4/21/20251/23/2026Medical Necessity Criteria;Medical Coding1/23/2026
Reissue PoliciesAcupuncture12.00.01i1/1/20251/21/20261/21/2026
Reissue PoliciesNucleoplasty11.15.19e5/7/20141/21/20261/21/2026
Reissue PoliciesEvaluation and Treatment of Erectile Dysfunction (ED)11.11.01k1/2/20241/21/20261/21/2026
Reissue PoliciesCryosurgical Ablation of the Prostate Gland11.11.03d4/6/20151/21/20261/21/2026
Reissue PoliciesSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence11.17.04z10/1/20241/21/20261/21/2026
Coding UpdateIntravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)08.01.80e1/1/20261/1/2026
Coding UpdateEnzyme Replacement for the Treatment of Gaucher's Disease08.00.51m1/2/20261/2/2026
Coding UpdateIntra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis11.14.07z1/2/20261/2/2026
Coding UpdatePercutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (AmeriHealth)11.02.27m1/1/20261/2/2026
Coding UpdateTherapeutic Transcranial Magnetic Stimulation (TMS)07.03.22h1/1/20261/2/2026
Coding UpdateEnzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., elapegademase-lvlr [Revcovi])08.01.26e1/2/20261/2/2026
Coding UpdateIntensity-Modulated Radiation Therapy (IMRT) (AmeriHealth Administrators)09.00.17r1/1/20261/2/2026
Coding UpdateReconstructive Breast Surgery and Post-Mastectomy Prostheses 11.08.15ad1/1/20261/2/2026
Coding UpdateProton Beam Radiation Therapy (AmeriHealth Administrators)09.00.49o1/1/20261/2/2026
Coding UpdateBrachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy09.00.10aa1/1/20261/2/2026
Coding UpdateTumor Treating Fields07.03.26b1/1/20261/2/2026
Coding UpdateRoutine/Non-routine Vaccines08.01.04ah1/1/20261/2/2026
Coding UpdatePsychiatric Collaborative Care Management (CoCM) (AmeriHealth)00.01.70b1/1/20261/2/2026
Coding UpdateReimbursement for the Administration of Immunizations07.00.15o1/1/20261/2/2026
Coding UpdateGender-Affirming Interventions11.09.02s1/1/20261/2/2026
Coding UpdateTreatments for Complex Regional Pain Syndrome (CRPS)08.00.57u1/1/20261/2/2026
Coding UpdateTreatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence11.02.01v1/1/20261/2/2026
Coding UpdateHigh-Technology Radiology Services (AmeriHealth)09.00.46au1/1/20261/2/2026
Coding UpdatePercutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis11.15.22e1/1/20261/2/2026
Coding UpdateMusculoskeletal Services (AmeriHealth)00.01.66r1/1/20261/2/2026
Coding UpdatePercutaneous Discectomy11.15.15h1/1/20261/2/2026
Coding UpdateSpinal Discectomy (AmeriHealth Administrators)11.14.29i1/1/20261/2/2026
Coding UpdateAblation of Lung Tumors11.00.16k1/1/20261/2/2026
Coding UpdateBariatric Surgery11.03.02w1/1/20261/2/2026
Coding UpdateEndovascular Stent Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions11.02.17j1/1/20261/2/2026
Coding UpdatePhotodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])07.07.03o1/1/20261/2/2026
Coding Update​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy07.00.14i1/1/20261/2/2026
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20ar1/1/20261/2/2026
Coding UpdateProcedures for the Treatment of Gastroesophageal Reflux Disease (GERD)11.03.11r1/1/20261/2/2026
Coding UpdateSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence11.17.04z1/1/20261/2/2026
Coding UpdateSurgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)11.17.06w1/1/20261/2/2026
Coding UpdateScar Revision11.08.25o1/1/20261/2/2026
Coding UpdateIntravenous Infliximab and Related Biosimilars08.00.34x1/1/20261/2/2026
Coding Updatelinvoseltamab-gcpt (Lynozyfic™)08.02.47a1/1/20261/2/2026
Coding UpdateAsparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)08.01.35k1/1/20261/2/2026
Coding UpdateTelisotuzumab vedotin-tllv (Emrelis™)08.02.45a1/1/20261/2/2026
Coding UpdateBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus00.10.39r1/1/20261/6/2026
Coding UpdateMusculoskeletal Services (AmeriHealth)00.01.66r1/1/20261/6/2026
Coding UpdateCare Management and Care Planning Services00.01.59p1/1/20261/7/2026
Coding UpdateTreatments for Complex Regional Pain Syndrome (CRPS)08.00.57u1/1/20261/8/20261/8/2026
Coding UpdateTreatments for Complex Regional Pain Syndrome (CRPS)08.00.57u1/1/20261/8/2026
Coding UpdateBundled Procedure Codes00.01.52z1/1/20261/9/2026
Coding UpdateDirect Access to Obstetrics/Gynecology (OB/GYN) Services00.09.01m1/1/20261/9/2026
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 Service03.00.06ad1/1/20261/12/2026
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08v1/1/20261/13/20261/13/2026
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08v1/1/20261/13/2026
Coding UpdateNew Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances00.01.55ab1/1/20261/14/2026
Coding UpdateRadiologic Guidance and/or Supervision and Interpretation of a Procedure00.10.36v1/1/20261/22/2026