| News & Announcements | Coverage of the COVID-19 Vaccination for AmeriHealth Members (Retroactively effective to March 14, 2023. Issued April 12, 2023) | | | | | | 4/12/2023 | | | |
| New Policies | Prescription Digital Therapeutics and Mobile-Based Health Management Applications | 12.00.05 | 3/10/2023 11:00 AM | 4/10/2023 | | | 4/10/2023 | This is a New Policy. | 4/10/2023 | |
| New Policies | Mirvetuximab soravtansine-gynx (Elahere TM) | 08.02.01 | | 4/24/2023 | | | 4/24/2023 | This is a New Policy. | | |
| Updated Policies | Atezolizumab (Tecentriq®) | 08.01.69c | 3/3/2023 9:00 AM | 4/3/2023 | | | 4/3/2023 | Medical Necessity Criteria | | |
| Updated Policies | Insertion of Implantable Infusion Pumps | 11.15.03m | 3/10/2023 9:00 AM | 4/10/2023 | | | 4/10/2023 | Medical Necessity Criteria | | |
| Updated Policies | Musculoskeletal Services (AmeriHealth) | 00.01.66h | | 4/9/2023 | | | 4/10/2023 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Botulinum Toxin Agents | 08.00.26aa | | 4/10/2023 | | | 4/10/2023 | Medical Necessity Criteria | | |
| Updated Policies | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | 08.01.08l | | 4/1/2023 | | | 4/10/2023 | Medical Coding | | |
| Updated Policies | Treatment of Medical and Surgical Complications | 11.00.02g | | 4/10/2023 | | | 4/10/2023 | Coverage and/or Reimbursement Position;Medical Coding | | |
| Updated Policies | High-Technology Radiology Services (AmeriHealth) | 09.00.46an | | 4/9/2023 | | | 4/10/2023 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Maintenance Treatment of Opioid or Alcohol Use Disorder | 08.01.37c | | 4/10/2023 | | | 4/10/2023 | Medical Necessity Criteria | | |
| Updated Policies | Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter | 07.03.21m | | 4/10/2023 | | | 4/10/2023 | Medical Coding | | |
| Updated Policies | Pembrolizumab (Keytruda®) | 08.01.63d | | 4/10/2023 | | | 4/10/2023 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Elective Abortion | 11.06.02k | | 4/10/2023 | | | 4/10/2023 | Medical Necessity Criteria | | |
| Updated Policies | Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers | 00.10.01ah | | 4/1/2023 | | | 4/12/2023 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Ankle-Foot/Knee-Ankle-Foot Orthoses | 05.00.39s | 3/14/2023 9:00 AM | 4/13/2023 | | | 4/13/2023 | Coverage and/or Reimbursement Position;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Manual Wheelchairs | 05.00.12j | | 4/13/2023 | | | 4/13/2023 | Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Seat Lift Mechanisms | 05.00.43h | | 4/13/2023 | | | 4/13/2023 | Medical Necessity Criteria | | |
| Updated Policies | Hospital Beds and Accessories | 05.00.56l | | 4/17/2023 | | | 4/17/2023 | Coverage and/or Reimbursement Position;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 | 00.01.25bj | | 4/1/2023 | | | 4/17/2023 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Experimental/Investigational Services | 12.01.01bh | | 4/1/2023 | | | 4/21/2023 | Medical Coding | | |
| Updated Policies | Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT) | 05.00.75a | | 4/24/2023 | | | 4/24/2023 | Coverage and/or Reimbursement Position | | |
| Reissue Policies | Fetal Fibronectin Enzyme (fFN) Immunoassay | 06.02.04d | | 12/4/2015 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators) | 06.02.29d | | 7/1/2016 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | Preimplantation Genetic Testing (AmeriHealth Administrators) | 06.02.24j | | 10/1/2016 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | Teprotumumab-trbw (Tepezza®) | 08.00.41a | | 6/6/2022 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | Genetic Testing for Congenital Long QT Syndrome (AmeriHealth Administrators) | 06.02.31g | | 1/1/2021 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (AmeriHealth Administrators) | 06.02.09g | | 7/1/2016 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth | 04.00.05d | | 3/26/2014 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®) | 08.00.91e | | 1/4/2021 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | Surgical Treatment of Femoroacetabular Impingement (Amerihealth Administrators) | 11.14.23d | | 1/10/2021 | 4/5/2023 | | 4/5/2023 | | | |
| Reissue Policies | Spinal Cord Ganglion and Dorsal Root Ganglion Stimulation (Amerihealth Administrators) | 11.15.01x | | 1/10/2021 | 4/5/2023 | | 4/6/2023 | | | |
| Reissue Policies | Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Amerihealth Administrators) | 11.14.06j | | 1/10/2021 | 4/5/2023 | | 4/6/2023 | | | |
| Reissue Policies | Denervation of the Spinal Nerves for Chronic Pain (Amerihealth Administrators) | 11.15.09p | | 10/1/2021 | 4/5/2023 | | 4/6/2023 | | | |
| Reissue Policies | Meniscal Allograft Transplantation and Meniscal Implants (Amerihealth Administrators) | 11.14.03h | | 1/10/2021 | 4/5/2023 | | 4/6/2023 | | | |
| Reissue Policies | Osteochondral Allograft Transplantation (Amerihealth Administrators) | 11.14.12f | | 1/10/2021 | 4/5/2023 | | 4/6/2023 | | | |
| Reissue Policies | Spinal Discectomy (Amerihealth Administrators) | 11.14.29h | | 7/1/2021 | 4/5/2023 | | 4/6/2023 | | | |
| Reissue Policies | Osteochondral Autograft Transplantation (Amerihealth Administrators) | 11.14.09h | | 1/10/2021 | 4/5/2023 | | 4/6/2023 | | | |
| Reissue Policies | Intraoperative Neurophysiological Monitoring (INM) | 07.03.14q | | 1/3/2022 | 4/5/2023 | | 4/6/2023 | | | |
| Reissue Policies | Preimplantation Genetic Testing (AmeriHealth Administrators) | 06.02.24j | | 10/1/2016 | 4/5/2023 | | 4/10/2023 | | | |
| Reissue Policies | Belimumab (Benlysta®) for Intravenous Use | 08.00.99e | | 10/24/2022 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Ocrelizumab (Ocrevus®) | 08.01.38c | | 9/17/2019 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Alemtuzumab (Lemtrada®) | 08.01.22d | | 5/4/2020 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®) | 08.01.72a | | 3/21/2022 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Spinal Laminectomy (Amerihealth Administrators) | 11.14.28e | | 1/1/2022 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Spinal Fusion (Amerihealth Administrators) | 11.14.27f | | 1/1/2022 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Frenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie) | 11.03.05e | | 1/1/2021 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty (Amerihealth Administrators) | 11.14.10t | | 1/1/2023 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Artificial Intervertebral Cervical Disc Insertion (Amerihealth Administrators) | 11.14.19p | | 1/10/2021 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Risankizumab-rzaa (Skyrizi®) for Intravenous Use | 08.01.95a | | 1/1/2023 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Efgartigimod alfa - fcab (VyvgartTM) | 08.01.84b | | 7/1/2022 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Tebentafusp-tebn (Kimmtrak®) | 08.01.85b | | 10/1/2022 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Surgical Correction of Strabismus | 11.05.07d | | 9/7/2016 | 4/19/2023 | | 4/20/2023 | | | |
| Reissue Policies | Tildrakizumab-asmn (Ilumya®) | 08.01.48b | | 2/24/2020 | 4/19/2023 | | 4/21/2023 | | | |
| Reissue Policies | Full-Body Computerized Tomography (CT) Scan Screening | 09.00.24c | | 3/25/2015 | 4/19/2023 | | 4/21/2023 | | | |
| Coding Update | eviCore Lab Management (AmeriHealth) | 06.02.52ab | | 4/1/2023 | | | 4/3/2023 | | | |
| Coding Update | Immune Prophylaxis for Respiratory Syncytial Virus (RSV) | 08.00.22p | | 4/1/2023 | | | 4/5/2023 | | | |
| Coding Update | Preventive Care Services | 00.06.02al | | 4/1/2023 | | | 4/5/2023 | | 4/5/2023 | |
| Coding Update | Pemetrexed (Alimta®), Pemetrexed (Pemfexy™) | 08.00.87k | | 4/1/2023 | | | 4/6/2023 | | | |
| Coding Update | Compression Garments | 05.00.37g | | 4/1/2023 | | | 4/6/2023 | | | |
| Coding Update | Gender Affirming Interventions | 11.09.02m | | 4/1/2023 | | | 4/10/2023 | | | |
| Coding Update | Teclistamab-cqyv (Tecvayli™) | 08.01.98a | | 4/1/2023 | | | 4/10/2023 | | | |
| Coding Update | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | 08.00.66t | | 4/1/2023 | | | 4/10/2023 | | | |
| Coding Update | Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products | 00.03.07aj | | 4/1/2023 | | | 4/13/2023 | | | |
| Coding Update | Durable Medical Equipment (DME) and Consumable Medical Supplies | 05.00.21ab | | 4/1/2023 | | | 4/14/2023 | | | |
| Coding Update | Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices | 05.00.44p | | 4/1/2023 | | | 4/14/2023 | | | |