| News & Announcements | Notification of Policy Update for 00.06.02ar: Preventive Care Services Applicable to AmeriHealth Commercial Members | | | | | | 4/2/2024 | | | |
| News & Announcements | 4/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | | | | | | 4/23/2024 | | | |
| Notifications | Evinacumab-dgnb (Evkeeza®) | 08.01.76c | 4/24/2024 10:00 AM | 5/27/2024 | | | 4/24/2024 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| New Policies | Talquetamab-tgvs (Talvey™) | 08.02.16 | | 4/1/2024 | | | 4/1/2024 | This is a New Policy. | | |
| New Policies | Pozelimab-bbfg (Veopoz TM) | 08.02.17 | | 4/1/2024 | | | 4/1/2024 | This is a New Policy. | | |
| New Policies | Elranatamab-bcmm (Elrexfio™) | 08.02.18 | | 4/22/2024 | | | 4/22/2024 | This is a New Policy. | | |
| Updated Policies | Natalizumab (Tysabri®) and Related Biosimilars | 08.00.64h | | 4/1/2024 | | | 4/1/2024 | Medical Necessity Criteria | | |
| Updated Policies | Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors | 08.00.74w | | 4/1/2024 | | | 4/1/2024 | Medical Necessity Criteria | | |
| Updated Policies | Radiation Therapy Services (AmeriHealth Administrators) | 09.00.56r | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria | | |
| Updated Policies | Ankle-Foot/Knee-Ankle-Foot Orthoses | 05.00.39u | | 4/8/2024 | | | 4/8/2024 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Knee Orthoses | 05.00.47r | 3/8/2024 10:00 AM | 4/8/2024 | | | 4/8/2024 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Mosunetuzumab-axgb (Lunsumio™) | 08.02.00b | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria | | |
| Updated Policies | Tisotumab vedotin-tftv (Tivdak®) | 08.01.83c | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria | | |
| Updated Policies | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | 08.01.32l | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery | 11.02.12k | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria | | |
| Updated Policies | Teclistamab-cqyv (Tecvayli®) | 08.01.98c | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Nivolumab and Relatlimab-rmbw (Opdualag™) | 08.01.94c | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Pertuzumab (Perjeta®) | 08.01.07j | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Pemetrexed (Pemfexy™) | 08.00.87m | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Enfortumab vedotin-ejfv (Padcev®) | 08.00.43f | | 4/8/2024 | | | 4/8/2024 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | High-Technology Radiology Services (AmeriHealth) | 09.00.46aq | | 4/14/2024 | | | 4/15/2024 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Musculoskeletal Services (AmeriHealth) | 00.01.66l | | 4/14/2024 | | | 4/15/2024 | Medical Necessity Criteria | | |
| Updated Policies | PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services | 00.01.25bn | | 4/1/2024 | | | 4/19/2024 | Coverage and/or Reimbursement Position | | |
| Updated Policies | New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances | 00.01.55w | | 4/1/2024 | 4/1/2024 | | 4/19/2024 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Cochlear Implantation | 11.01.02r | | 4/22/2024 | | | 4/22/2024 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | 11.01.06i | | 4/22/2024 | | | 4/22/2024 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Erythropoiesis-Stimulating Agents (ESAs) | 08.00.75p | | 4/22/2024 | | | 4/22/2024 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems | 05.00.79j | | 4/22/2024 | | | 4/22/2024 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Pressure-Reducing Support Surfaces | 05.00.60k | | 4/22/2024 | | | 4/22/2024 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ ) | 08.00.72l | | 4/22/2024 | | | 4/22/2024 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease | 08.01.93c | | 7/7/2023 | | | 4/23/2024 | Medical Coding;General Description, Guidelines, or Informational Update | | |
| Reissue Policies | Pulse Oximetry Devices in the Home Setting | 05.00.31e | | 5/7/2018 | 4/3/2024 | | 4/3/2024 | | | |
| Reissue Policies | Composite Tissue Allotransplantation of the Hand(s) and Face | 11.14.30 | | 5/19/2017 | 4/3/2024 | | 4/3/2024 | | | |
| Reissue Policies | Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®) | 08.01.72a | | 3/21/2022 | 4/3/2024 | | 4/3/2024 | | | |
| Reissue Policies | Tebentafusp-tebn (Kimmtrak®) | 08.01.85b | | 10/1/2022 | 4/3/2024 | | 4/3/2024 | | | |
| Reissue Policies | Intensity-Modulated Radiation Therapy (IMRT) (AmeriHealth Administrators) | 09.00.17q | | 11/6/2023 | 4/3/2024 | | 4/3/2024 | | | |
| Reissue Policies | Hospital Beds and Accessories | 05.00.56l | | 4/17/2023 | 4/3/2024 | | 4/3/2024 | | | |
| Reissue Policies | Intensity-Modulated Radiation Therapy (IMRT) (AmeriHealth Administrators) | 09.00.17q | | 11/6/2023 | 4/3/2024 | | 4/8/2024 | | | |
| Reissue Policies | Acute Care Facility Inpatient Transfers | 12.04.04b | | 1/1/2023 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Pharmacogenetic Testing to Determine Drug Sensitivity (AmeriHealth Administrators) | 06.02.30f | | 1/1/2023 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™) | 06.02.43b | | 2/1/2017 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Labiaplasty | 11.06.09d | | 5/14/2018 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Ocrelizumab (Ocrevus®) | 08.01.38c | | 9/17/2019 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators) | 09.00.58 | | 8/14/2023 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Autonomic Nervous System Testing | 07.03.23f | | 10/1/2022 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Manual Wheelchairs | 05.00.12j | | 4/13/2023 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (AmeriHealth Administrators) | 06.02.18m | | 1/1/2023 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Preimplantation Genetic Testing (AmeriHealth Administrators) | 06.02.24j | | 10/1/2016 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Full-Body Computerized Tomography (CT) Scan Screening | 09.00.24c | | 3/25/2015 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis | 11.15.22d | | 1/1/2017 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Migraine Deactivation Surgery | 11.15.24a | | 3/11/2015 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Alemtuzumab (Lemtrada®) | 08.01.22d | | 5/4/2020 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Colorectal Cancer Screening | 11.03.12t | | 7/1/2021 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (AmeriHealth Administrators) | 06.02.09g | | 7/1/2016 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Genetic Testing for Congenital Long QT Syndrome (AmeriHealth Administrators) | 06.02.31g | | 1/1/2021 | 4/17/2024 | | 4/17/2024 | | | |
| Reissue Policies | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (AmeriHealth Administrators) | 06.02.32d | | 7/1/2016 | 4/17/2024 | | 4/17/2024 | | | |
| Coding Update | Trigger Point Injections | 11.14.02r | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Self-Administered Drugs | 08.00.78aq | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | 08.01.08p | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents | 00.10.43f | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes | 05.00.05r | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring | 11.00.06t | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Wheelchair Options and Accessories | 05.00.67t | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Vedolizumab (Entyvio®) for Injection for Intravenous Use | 08.01.18h | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Nadofaragene Firadenovec-vncg (Adstiladrin®) | 08.02.11a | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds | 11.08.20ak | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Treatments for Complex Regional Pain Syndrome (CRPS) | 08.00.57r | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Elective Abortion | 11.06.02m | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Tocilizumab (Actemra®) for Intravenous Infusion | 08.00.85o | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Fertility Preservation (AmeriHealth New Jersey) | 07.10.08b | | 4/1/2024 | | | 4/1/2024 | | | |
| Coding Update | Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence | 11.17.04x | | 4/1/2024 | | | 4/2/2024 | | | |
| Coding Update | Treatment of Twin-Twin Transfusion Syndrome (TTTS) | 11.00.14g | | 4/1/2024 | | | 4/2/2024 | | | |
| Coding Update | Biofeedback Therapy | 07.00.01l | | 4/1/2024 | | | 4/2/2024 | | | |
| Coding Update | Genetic Testing (AmeriHealth Administrators) | 06.02.35am | | 1/1/2024 | | | 4/3/2024 | | | |
| Coding Update | Modifier 50: Bilateral Procedure | 03.00.05x | | 4/1/2024 | | | 4/5/2024 | | | |
| Coding Update | Modifier 62: Two Surgeons | 00.10.11y | | 4/1/2024 | | | 4/5/2024 | | | |
| Coding Update | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 00.10.18w | | 4/1/2024 | | | 4/5/2024 | | | |
| Coding Update | Complementary and Integrative Health Services | 12.00.03h | | 4/1/2024 | | | 4/8/2024 | | | |
| Coding Update | Lower Limb Prostheses | 05.00.59n | | 4/1/2024 | | | 4/12/2024 | | | |
| Coding Update | Prescription Digital Therapeutics and Mobile-Based Health Management Applications | 12.00.05b | | 4/1/2024 | | | 4/12/2024 | | | |
| Coding Update | Durable Medical Equipment (DME) and Consumable Medical Supplies | 05.00.21ad | | 4/1/2024 | | | 4/12/2024 | | | |
| Coding Update | Preventive Care Services | 00.06.02aq | | 4/1/2024 | | | 4/19/2024 | | | |
