| News & Announcements | 4/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | | | | | | 4/1/2021 | | | |
| News & Announcements | Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) For AmeriHealth Pennsylvania Members (Updated April 20, 2021) | | | | | | 4/20/2021 | | | |
| Notifications | Telemedicine Services (AmeriHealth Pennsylvania) | 00.10.41h | 4/1/2021 5:00 PM | 7/1/2021 | | | 4/1/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | 6/30/2021 | |
| Notifications | Spinal Discectomy (Amerihealth Administrators) | 11.14.29h | 4/1/2021 11:00 AM | 7/1/2021 | | | 4/1/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Notifications | Contrast Agents Used in Conjunction with Echocardiography | 09.00.11e | 4/2/2021 2:00 PM | 5/3/2021 | | | 4/2/2021 | General Description, Guidelines, or Informational Update | | |
| Notifications | Routine Costs Associated with Qualifying Clinical Trials | 07.00.20g | 4/6/2021 2:00 PM | 7/5/2021 | | | 4/6/2021 | General Description, Guidelines, or Informational Update | | |
| Notifications | Teprotumumab (Tepezza™) | 08.00.41 | 4/23/2021 9:00 AM | 5/24/2021 | | | 4/23/2021 | This is a New Policy. | | |
| New Policies | Trilaciclib (Cosela™) | 08.01.77 | | 4/26/2021 | | | 4/26/2021 | This is a New Policy. | | |
| Updated Policies | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | 08.01.08e | | 4/1/2021 | | | 4/1/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services | 00.01.25bb | | 4/1/2021 | | | 4/1/2021 | Coverage and/or Reimbursement Position | | |
| Updated Policies | pegfilgrastim (Neulasta®) and related biosimilars | 08.01.32e | 12/31/2020 2:00 PM | 4/1/2021 | | | 4/1/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances | 00.01.55q | | 4/1/2021 | | | 4/1/2021 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Cochlear Implant | 11.01.02p | | 4/12/2021 | | | 4/12/2021 | Medical Necessity Criteria | | |
| Updated Policies | Intensity-Modulated Radiation Therapy (IMRT) (AmeriHealth Administrators) | 09.00.17p | | 4/12/2021 | | | 4/12/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria | | |
| Updated Policies | Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars | 08.00.74o | | 4/12/2021 | | | 4/12/2021 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Wheelchair Options and Accessories | 05.00.67q | 3/12/2021 2:00 PM | 4/12/2021 | | | 4/12/2021 | Medical Necessity Criteria | | |
| Updated Policies | Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices | 05.00.54h | 3/12/2021 2:00 PM | 4/12/2021 | | | 4/12/2021 | Medical Necessity Criteria | | |
| Updated Policies | Magnetic Resonance Imaging (MRI) Contrast Agents | 09.00.45i | | 4/12/2021 | | | 4/12/2021 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta) | 08.00.33p | | 4/12/2021 | | | 4/15/2021 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Bortezomib (Bortezomib for Injection, Velcade®) | 08.00.73m | | 4/12/2021 | | | 4/19/2021 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Experimental/Investigational Services | 12.01.01az | | 4/1/2021 | | | 4/26/2021 | Coverage and/or Reimbursement Position;Medical Coding | | |
| Reissue Policies | Speech Therapy | 10.06.01l | | 1/1/2020 | 4/7/2021 | | 4/7/2021 | | | |
| Reissue Policies | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (AmeriHealth Administrators) | 06.02.47d | | 4/1/2020 | 3/24/2021 | | 4/8/2021 | | | |
| Reissue Policies | Genetic Testing for Congenital Long QT Syndrome (AmeriHealth Administrators) | 06.02.31g | | 1/1/2021 | 3/24/2021 | | 4/9/2021 | | | |
| Reissue Policies | GPS Cancer™ Testing by NantHealth | 06.02.50 | | 3/1/2016 | 3/24/2021 | | 4/9/2021 | | | |
| Reissue Policies | Fetal Fibronectin Enzyme (fFN) Immunoassay | 06.02.04d | | 12/4/2015 | 3/24/2021 | | 4/9/2021 | | | |
| Reissue Policies | Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (AmeriHealth Administrators) | 06.02.10r | | 1/1/2021 | 3/24/2021 | | 4/9/2021 | | | |
| Reissue Policies | VeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer | 06.02.49b | | 5/6/2016 | 3/24/2021 | | 4/9/2021 | | | |
| Reissue Policies | Vectra® DA Blood Test for Rheumatoid Arthritis | 06.02.45 | | 2/1/2016 | 3/24/2021 | | 4/9/2021 | | | |
| Reissue Policies | Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (AmeriHealth Administrators) | 06.02.09g | | 7/1/2016 | 3/24/2021 | | 4/9/2021 | | | |
| Reissue Policies | Immune Cell Function Assay | 06.02.37a | | 11/6/2015 | 3/24/2021 | | 4/9/2021 | | | |
| Reissue Policies | Repository Corticotropin (H.P. Acthar® Gel Injection) | 08.01.12b | | 7/1/2015 | 4/7/2021 | | 4/9/2021 | | | |
| Reissue Policies | Upper Limb Prostheses | 05.00.72f | | 4/15/2019 | 4/7/2021 | | 4/22/2021 | | | |
| Reissue Policies | In Vitro Allergy Testing | 06.02.26d | | 3/25/2019 | 4/21/2021 | | 4/23/2021 | | | |
| Reissue Policies | In Vivo Allergy Sensitivity Testing | 07.00.05h | | 1/1/2021 | 4/21/2021 | | 4/23/2021 | | | |
| Reissue Policies | Allergy Immunotherapy | 07.00.21j | | 1/1/2021 | 4/21/2021 | | 4/23/2021 | | | |
| Reissue Policies | Insertion of Implantable Infusion Pumps | 11.15.03k | | 2/17/2020 | 4/21/2021 | | 4/26/2021 | | | |
| Reissue Policies | Nerve Fiber Density Testing | 06.02.38d | | 1/1/2019 | 4/21/2021 | | 4/30/2021 | | | |
| Reissue Policies | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (AmeriHealth Administrators) | 06.02.32d | | 7/1/2016 | 4/21/2021 | | 4/30/2021 | | | |
| Reissue Policies | Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators) | 06.02.27l | | 1/1/2019 | 4/21/2021 | | 4/30/2021 | | | |
| Reissue Policies | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators) | 06.02.29d | | 7/1/2016 | 4/21/2021 | | 4/30/2021 | | | |
| Reissue Policies | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (AmeriHealth Administrators) | 06.02.36c | | 6/17/2019 | 4/21/2021 | | 4/30/2021 | | | |
| Coding Update | Vagus Nerve Stimulation (VNS) | 11.15.16p | | 4/1/2021 | | | 4/1/2021 | | | |
| Coding Update | Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis | 11.14.07x | | 4/1/2021 | | | 4/1/2021 | | | |
| Coding Update | Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG) | 08.00.13ab | | 4/1/2021 | | | 4/1/2021 | | | |
| Coding Update | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | 11.14.21i | | 4/1/2021 | | | 4/1/2021 | | | |
| Coding Update | Ankle-Foot/Knee-Ankle-Foot Orthoses | 05.00.39q | | 4/1/2021 | | | 4/1/2021 | | | |
| Coding Update | Implantable Steroid-Eluting Sinus Stents | 11.16.08e | | 4/1/2021 | | | 4/1/2021 | | | |
| Coding Update | Chimeric Antigen Receptor (CAR) Therapy | 08.01.43g | | 4/1/2021 | | | 4/1/2021 | | | |
| Coding Update | Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)) | 08.01.34a | | 4/1/2021 | | | 4/1/2021 | | | |
| Coding Update | Genetic Testing (AmeriHealth Administrators) | 06.02.35ab | | 4/1/2021 | | | 4/2/2021 | | | |
| Coding Update | eviCore Lab Management (AmeriHealth) | 06.02.52t | | 4/1/2021 | | | 4/2/2021 | | | |
| Coding Update | Modifier 50: Bilateral Procedure | 03.00.05p | | 4/1/2021 | | | 4/5/2021 | | | |
| Coding Update | Belantamab mafodotin-blmf (Blenrep) | 08.01.70b | | 4/1/2021 | | | 4/5/2021 | | | |
| Coding Update | Always Bundled Procedure Codes | 00.01.52l | | 4/1/2021 | | | 4/5/2021 | | | |
| Coding Update | Modifier 62: Two Surgeons | 00.10.11p | | 4/1/2021 | | | 4/5/2021 | | | |
| Coding Update | Reimbursement for Radiopharmaceutical Agents for Professional Providers | 09.00.32w | | 4/1/2021 | | | 4/5/2021 | | | |
| Coding Update | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 00.10.18o | | 4/1/2021 | | | 4/8/2021 | | | |
| Coding Update | Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices | 05.00.44n | | 4/1/2021 | | | 4/8/2021 | | | |
| Coding Update | Durable Medical Equipment (DME) and Consumable Medical Supplies | 05.00.21x | | 4/1/2021 | | | 4/8/2021 | | | |
| Coding Update | PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services | 00.01.25bc | | 4/2/2021 | | | 4/14/2021 | | | |
| Coding Update | Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products | 00.03.07ac | | 4/1/2021 | 4/14/2021 | | 4/14/2021 | | | |