| News & Announcements | 04/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | | | | | | 4/1/2025 | | | |
| News & Announcements | Clarification on the coverage of Meningococcal (Groups A, C, W, and Y) conjugate vaccines for Commercial Members (Retroactively Effective to November 18, 2024) | | | | | | 4/22/2025 | | | |
| Notifications | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | 07.02.21r | 4/22/2025 12:00 PM | 7/21/2025 | | | 4/22/2025 | Medical Necessity Criteria | | |
| New Policies | Nogapendekin alfa inbakicept-pmln (Anktiva®) | 08.02.26 | | 4/21/2025 | | | 4/21/2025 | This is a New Policy. | | |
| New Policies | Zolbetuximab-clzb (Vyloy®) | 08.02.36 | | 4/21/2025 | | | 4/21/2025 | This is a New Policy. | | |
| New Policies | Tarlatamab-dlle (Imdelltra™) for intravenous use | 08.02.27 | | 4/21/2025 | | | 4/21/2025 | This is a New Policy. | | |
| New Policies | Zanidatamab-hrii (Ziihera®) | 08.02.39 | | 4/21/2025 | | | 4/21/2025 | This is a New Policy. | | |
| Updated Policies | Telemedicine Services | 00.10.41o | | 4/7/2025 | | | 4/7/2025 | Medical Coding | | |
| Updated Policies | Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy | 07.00.03q | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Pembrolizumab (Keytruda®) | 08.01.63f | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | 07.02.09k | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Botulinum Toxin Agents | 08.00.26ad | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) | 07.13.06p | | 4/21/2025 | | | 4/21/2025 | Medical Coding | | |
| Updated Policies | Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™) | 08.01.38d | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents | 08.00.25o | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Updated Policies | Intravenous Infliximab and Related Biosimilars | 08.00.34v | | 4/21/2025 | | | 4/21/2025 | Medical Necessity Criteria | | |
| Reissue Policies | Surgery for Gynecomastia | 11.08.12i | | 1/1/2024 | 4/2/2025 | | 4/2/2025 | | | |
| Reissue Policies | Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis | 11.15.22d | | 1/1/2017 | 4/2/2025 | | 4/2/2025 | | | |
| Reissue Policies | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | 11.16.06k | | 10/21/2024 | 4/2/2025 | | 4/2/2025 | | | |
| Reissue Policies | Home-Based Sleep Studies | 07.03.01d | | 10/1/2024 | 4/2/2025 | | 4/2/2025 | | | |
| Reissue Policies | Osteochondral Allograft Transplantation (Amerihealth Administrators) | 11.14.12f | | 1/10/2021 | 4/2/2025 | | 4/3/2025 | | | |
| Reissue Policies | Osteochondral Autograft Transplantation (Amerihealth Administrators) | 11.14.09h | | 1/10/2021 | 4/2/2025 | | 4/3/2025 | | | |
| Reissue Policies | Manual Wheelchairs | 05.00.12j | | 4/13/2023 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Seat Lift Mechanisms | 05.00.43h | | 4/13/2023 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Patient Lifts | 05.00.42i | | 5/22/2023 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Wheelchair Cushions and Seating | 05.00.55l | | 8/14/2023 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Wheelchair Options and Accessories | 05.00.67u | | 4/1/2025 | | | 4/4/2025 | | | |
| Reissue Policies | Transcatheter Cardiac Valve Procedures | 11.02.25j | | 10/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery | 11.02.12k | | 4/8/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth | 04.00.05d | | 3/26/2014 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Pulse Oximetry Devices in the Home Setting | 05.00.31e | | 5/7/2018 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails | 11.08.17k | | 10/1/2021 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation | 11.02.26c | | 7/18/2022 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Pulmonary Rehabilitation | 10.04.01m | | 1/1/2022 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | 05.00.29o | | 10/1/2023 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Teclistamab-cqyv (Tecvayli®) | 08.01.98c | | 4/8/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Steroid-Eluting Sinus Stents and Implants | 11.16.08f | | 9/13/2021 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia | 05.00.77e | | 3/25/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Medical Nutrition Therapy (MNT)/Nutrition Counseling | 10.00.04 | | 1/1/2025 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Natalizumab (Tysabri®) and Related Biosimilars | 08.00.64h | | 4/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Alemtuzumab (Lemtrada®) | 08.01.22d | | 5/4/2020 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Fetal Fibronectin Enzyme (fFN) Immunoassay | 06.02.04d | | 12/4/2015 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Cryosurgical Ablation of the Prostate Gland | 11.11.03d | | 4/6/2015 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) | 05.00.81a | | 9/23/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Home Oxygen Therapy | 05.00.58o | | 7/17/2023 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Ultraviolet Light Therapy for the Treatment of Dermatological Conditions | 07.07.02o | | 10/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Solid Organ Transplantation and Procurement Cost of Organs and Tissues | 11.00.09g | | 6/17/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Compression Garments | 05.00.37i | | 1/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Hospital Beds and Accessories | 05.00.56l | | 4/17/2023 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Lower Limb Prostheses | 05.00.59p | | 10/1/2024 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Standing Frames | 05.00.71c | | 3/22/2017 | 4/2/2025 | | 4/4/2025 | | | |
| Reissue Policies | Enfortumab vedotin-ejfv (Padcev®) | 08.00.43f | | 4/8/2024 | 4/2/2025 | | 4/7/2025 | | | |
| Reissue Policies | Elranatamab-bcmm (Elrexfio™) | 08.02.18 | | 4/22/2024 | 4/2/2025 | | 4/7/2025 | | | |
| Reissue Policies | Negative Pressure Wound Therapy Systems | 05.00.38m | | 1/22/2024 | 4/2/2025 | | 4/7/2025 | | | |
| Reissue Policies | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional | 03.00.02c | | 6/21/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56) | 03.00.31g | | 10/25/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Amerihealth Administrators) | 11.14.06j | | 1/10/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional | 03.00.11c | | 6/21/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Meniscal Allograft Transplantation and Meniscal Implants (AmeriHealth Administrators) | 11.14.03h | | 1/10/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents | 00.10.43f | | 4/1/2024 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances | 00.01.45 | | 1/8/2010 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Routine Foot Care for Certain Medical Conditions | 07.07.01q | | 10/1/2021 | 4/16/2025 | | 4/16/2025 | | | |
| Reissue Policies | Trigger Point Injections | 11.14.02s | | 4/1/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Spinal Discectomy (AmeriHealth Administrators) | 11.14.29h | | 7/1/2021 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Surgical Treatment of Femoroacetabular Impingement (Amerihealth Administrators) | 11.14.23d | | 1/10/2021 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Triamcinolone Acetonide Extended-Release Injectable (Zilretta®) | 08.01.47a | | 1/1/2019 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators) | 09.00.58 | | 8/14/2023 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Ankle-Foot/Knee-Ankle-Foot Orthoses | 05.00.39v | | 4/8/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Percutaneous Intradiscal Annuloplasty (IDET/PIRFT) | 11.14.14e | | 7/1/2013 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty (AmeriHealth Administrators) | 11.14.10t | | 1/1/2023 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Lipectomy and Liposuction | 11.08.03m | | 10/9/2023 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Reduction Mammoplasty | 11.08.02l | | 6/3/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Therapeutic Shoes and Orthopedic Shoes | 05.00.11k | | 5/8/2023 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy | 11.08.19r | | 9/9/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | 08.01.08t | | 4/1/2025 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Inebilizumab-cdon (Uplizna) | 08.01.68b | | 8/9/2021 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Pegloticase (Krystexxa®) | 08.01.02h | | 3/27/2023 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Nucleoplasty | 11.15.19e | | 5/7/2014 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices | 05.00.54k | | 11/20/2023 | 4/30/2025 | | 4/30/2025 | | | |
| Reissue Policies | Breast Pumps | 05.00.76h | | 1/2/2024 | 4/30/2025 | | 4/30/2025 | | | |
| Coding Update | Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests | 00.01.24l | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant) | 11.07.01aa | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Reconstructive Breast Surgery and Post-Mastectomy Prostheses | 11.08.15ac | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Ankle-Foot/Knee-Ankle-Foot Orthoses | 05.00.39v | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | 05.00.70e | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Upper Limb Prostheses | 05.00.72h | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | 11.14.21l | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Trigger Point Injections | 11.14.02s | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems | 05.00.79l | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Filgrastim (Neupogen®) and Related Biosimilars, and tbo-filgrastim (Granix®) | 08.01.73h | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Wheelchair Options and Accessories | 05.00.67u | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Preventive Care Services | 00.06.02au | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Wheelchair Cushions and Seating | 05.00.55l | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds | 11.08.20ao | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM) | 08.01.69e | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Fertility Preservation (AmeriHealth New Jersey) | 07.10.08f | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors | 08.00.74y | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Coagulation Factors | 08.00.92ai | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | 08.01.08t | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®) for intravenous administration | 08.00.84l | | | | | 4/1/2025 | | | |
| Coding Update | Gender-Affirming Interventions | 11.09.02q | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Durable Medical Equipment (DME) and Consumable Medical Supplies | 05.00.21ag | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Modifier 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 Service | 03.00.06ac | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Reimbursement for Radiopharmaceutical Agents for Professional Providers | 09.00.32ai | | 4/1/2025 | | | 4/1/2025 | | | |
| Coding Update | Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices | 05.00.44s | | 4/1/2025 | | | 4/4/2025 | | | |
| Coding Update | Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products | 00.03.07ap | | 4/1/2025 | | | 4/4/2025 | | | |
| Coding Update | New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances | 00.01.55aa | | 4/1/2025 | | | 4/9/2025 | | | |
| Coding Update | Afamitresgene autoleucel (Tecelra®) | 08.02.32a | | 4/1/2025 | | | 4/14/2025 | | | |
| Coding Update | Compression Garments | 05.00.37j | | 4/1/2025 | 4/2/2025 | | 4/14/2025 | | | |
| Coding Update | PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services | 00.01.25bs | | 4/1/2025 | | | 4/15/2025 | | | |
| Coding Update | Preventive Care Services | 00.06.02au | | 4/1/2025 | | | 4/28/2025 | | | |
