It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again.
Toggle navigation
AH
Home
Currently selected
Contact Us
Commercial
Medical Policy
Policy Bulletins
Active Policy Notifications
Policy Types and Descriptions
Services Requiring Precertification
New Jersey
Pennsylvania
Clinical Relationship Logic
New Jersey
Pennsylvania
Coverage Guidelines
Select Cardiology Guidelines
Diagnostic Radiology Guidelines
Lab Management Guidelines
Musculoskeletal Guidelines
Radiation Therapy Guidelines
Sleep Disorder Management Guidelines
News & Announcements
Site Activity
Currently selected
Contact Us
MPDocType
Title
MPPolicyNumber
MPNotificationIssuedDate
MPEffectiveDate
MPReissuedDate
MPArchiveNotifEffDate
MPSALogCreatedOn
MPPolicyChangeTypeslt
MPRevisionDate
News & Announcements
Telemedicine Services for AmeriHealth Pennsylvania Members (Updated February 10, 2021)
2/10/2021
Notifications
Knee Orthoses
05.00.47o
2/12/2021 2:00 PM
3/15/2021
2/12/2021
Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated Policies
Experimental/Investigational Services
12.01.01ay
1/1/2021
2/1/2021
Medical Coding
Updated Policies
Seat Lift Mechanisms
05.00.43g
12/31/2020 8:00 AM
2/8/2021
2/8/2021
Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
Updated Policies
Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices
05.00.44m
12/31/2020 1:00 PM
2/8/2021
2/8/2021
Medical Coding
Updated Policies
Durable Medical Equipment (DME) and Consumable Medical Supplies
05.00.21w
12/31/2020 2:00 PM
2/8/2021
2/8/2021
Medical Coding
Updated Policies
Patient Lifts
05.00.42h
1/15/2021 1:00 PM
2/15/2021
2/15/2021
Coverage and/or Reimbursement Position
Updated Policies
Ankle-Foot/Knee-Ankle-Foot Orthoses
05.00.39p
1/15/2021 2:00 PM
2/15/2021
2/15/2021
Coverage and/or Reimbursement Position;Medical Coding
Updated Policies
Canakinumab (Ilaris®)
08.01.51a
2/15/2021
2/15/2021
Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated Policies
Ramucirumab (Cyramza®)
08.01.25e
2/15/2021
2/15/2021
Medical Necessity Criteria
Reissue Policies
Cranial Remolding Orthoses (Helmets)
05.00.25i
4/20/2020
2/10/2021
2/11/2021
Reissue Policies
Ibalizumab-uiyk (Trogarzo™)
08.01.46a
1/1/2019
2/24/2021
2/24/2021
Reissue Policies
Manipulation Under Anesthesia
11.14.24b
4/30/2018
2/24/2021
2/24/2021
Reissue Policies
Triamcinolone Acetonide Extended-Release Injectable (Zilretta™)
08.01.47a
1/1/2019
2/24/2021
2/24/2021
Reissue Policies
Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy
06.02.01j
4/20/2020
2/24/2021
2/25/2021
Reissue Policies
Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
07.02.09g
1/1/2020
2/24/2021
2/25/2021
Archived Policies
Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump
01.00.09c
2/26/2021 1:00 PM
3/29/2021
2/26/2021
Follow
javascript: SP.SOD.executeFunc('followingcommon.js', 'FollowDoc', function() { FollowDoc('{ListId}', {ItemId}); });
0x0
0x0
ContentType
0x01
1100
Compliance Details
javascript:if (typeof CalloutManager !== 'undefined' && Boolean(CalloutManager) && Boolean(CalloutManager.closeAll)) CalloutManager.closeAll(); commonShowModalDialog('{SiteUrl}'+ '/_layouts/15/itemexpiration.aspx' +'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/hold.aspx' +'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/Reporting.aspx' +'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/expirationconfig.aspx' +'?ID={ItemId}&List={ListId}'); return false;}}, null);
0x0
0x1
ContentType
0x01
898
Document Set Version History
/_layouts/15/images/versions.gif?rev=40
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+ '/_layouts/15/DocSetVersions.aspx' + '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
/_layouts/15/images/sendOtherLoc.gif?rev=40
javascript:GoToPage('{SiteUrl}' + '/_layouts/15/docsetsend.aspx' + '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350
Decline
Accept and go to Medical Policies
|
Decline