| Notifications | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®) for intravenous administration | 08.00.84j | 5/21/2024 10:00 AM | 8/19/2024 | | | 5/21/2024 | Medical Necessity Criteria | | |
| Notifications | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 00.01.68b | 5/31/2024 2:00 PM | 7/1/2024 | | | 5/31/2024 | Coverage and/or Reimbursement Position | | |
| New Policies | Auricular Prostheses | 05.00.82 | | 5/20/2024 | | | 5/20/2024 | This is a New Policy. | | |
| 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 | | | 5/1/2024 | Coverage and/or Reimbursement Position | | 5/1/2024 |
| 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 | | | 5/3/2024 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Botulinum Toxin Agents | 08.00.26ac | | 5/6/2024 | | | 5/6/2024 | Medical Necessity Criteria | | |
| Updated Policies | Experimental/Investigational Services | 12.01.01bl | | 4/1/2024 | | | 5/6/2024 | Medical Coding | | |
| Updated Policies | Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) | 08.01.65d | | 5/6/2024 | | | 5/6/2024 | Medical Necessity Criteria | | |
| Updated Policies | Mirvetuximab soravtansine-gynx (Elahere™) | 08.02.01b | | 5/20/2024 | | | 5/20/2024 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Mogamulizumab-kpkc (Poteligeo®) | 08.01.52f | | 5/20/2024 | | | 5/20/2024 | Medical Necessity Criteria | | |
| Updated Policies | Amivantamab-vmjw (Rybrevant®) | 08.01.90a | | 5/20/2024 | | | 5/20/2024 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Evinacumab-dgnb (Evkeeza®) | 08.01.76c | 4/24/2024 10:00 AM | 5/27/2024 | | | 5/28/2024 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Reissue Policies | Reimbursement for Components of Comprehensive Laboratory Panels | 00.01.61a | | 6/15/2020 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Seat Lift Mechanisms | 05.00.43h | | 4/13/2023 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Spinal Decompression with Interspinous and Interlaminar Devices | 11.14.22d | | 1/1/2017 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | High-Frequency Chest Wall Oscillation Devices | 05.00.14p | | 7/31/2023 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®) | 07.00.10j | | 7/3/2023 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45) | 08.01.34c | | 10/1/2021 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty | 11.16.01k | | 9/25/2023 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | 11.08.17k | | 10/1/2021 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Electroconvulsive Therapy (ECT) | 14.00.01a | | 10/1/2023 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Allergy Immunotherapy | 07.00.21j | | 1/1/2021 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Burosumab-twza (Crysvita®) | 08.01.49b | | 3/15/2021 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Intravenous Chelation Therapy | 07.00.02j | | 10/1/2023 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®) | 08.00.91e | | 1/4/2021 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS) | 07.03.15d | | 6/28/2017 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Screening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA) | 09.00.40d | | 2/18/2016 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Bone Mineral Density (BMD) Testing | 09.00.04o | | 1/2/2024 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Ventricular Assist Devices (VADs) | 11.02.16u | | 5/29/2023 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Patient Lifts | 05.00.42i | | 5/22/2023 | 5/1/2024 | | 5/1/2024 | | | |
| Reissue Policies | Billing Requirements for Multiple Births for Professional Providers | 00.10.38a | | 12/30/2019 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Instrument-Based Vision Screening | 07.13.12d | | 1/1/2016 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Complementary and Integrative Health Services | 12.00.03h | | 4/1/2024 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Bronchial Valves | 11.16.09 | | 4/1/2022 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | High Osmolar Contrast Agents | 09.00.13c | | 12/30/2015 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Voretigene Neparvovec-rzyl (Luxturna®) | 08.01.44c | | 1/1/2019 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Belimumab (Benlysta®) for Intravenous Use | 08.00.99e | | 10/24/2022 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Positron Emission Mammography (PEM) | 09.00.51a | | 11/6/2013 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Psychological Testing | 14.00.02 | | 1/1/2023 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Consultation Services | 00.01.69b | | 1/1/2023 | 5/15/2024 | | 5/15/2024 | | | |
| Reissue Policies | Nucleoplasty | 11.15.19e | | 5/7/2014 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies | 05.00.74i | | 10/1/2023 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) | 05.00.73g | | 7/31/2023 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Personalized Vaccines (e.g., Provenge®) | 08.00.95f | | 12/20/2021 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | 11.05.16l | | 1/1/2023 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | 05.00.70c | | 4/11/2022 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT) | 05.00.75a | | 4/24/2023 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Evaluation and Treatment of Erectile Dysfunction (ED) | 11.11.01k | | 1/2/2024 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | crizanlizumab-tmca (Adakveo®) | 08.00.04a | | 10/1/2023 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Removal of Breast Implants | 11.08.14n | | 6/5/2023 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Rozanolixizumab-noli (Rystiggo) | 08.02.08a | | 1/1/2024 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Maintenance Treatment of Opioid or Alcohol Use Disorder | 08.01.37c | | 4/10/2023 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Genetic Testing (AmeriHealth Administrators) | 06.02.35an | | 4/1/2024 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators) | 06.02.06r | | 10/1/2021 | 5/29/2024 | | 5/29/2024 | | | |
| 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 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics | 06.02.39d | | 1/1/2020 | 5/29/2024 | | 5/29/2024 | | | |
| Reissue Policies | Givosiran (Givlaari) | 08.00.21 | | 5/2/2022 | 5/29/2024 | | 5/30/2024 | | | |
| Coding Update | Elective Abortion | 11.06.02m | | 4/1/2024 | | | 5/1/2024 | | | 5/1/2024 |
| Coding Update | Elective Abortion | 11.06.02m | | 4/1/2024 | | | 5/1/2024 | | | |
| Coding Update | Durable Medical Equipment (DME) and Consumable Medical Supplies | 05.00.21ad | | 4/1/2024 | | | 5/3/2024 | | | 5/3/2024 |
| Coding Update | Durable Medical Equipment (DME) and Consumable Medical Supplies | 05.00.21ad | | 4/1/2024 | | | 5/6/2024 | | | |
| Coding Update | Genetic Testing (AmeriHealth Administrators) | 06.02.35an | | 4/1/2024 | | | 5/7/2024 | | | |
| Coding Update | eviCore Lab Management (AmeriHealth) | 06.02.52af | | 4/1/2024 | | | 5/7/2024 | | | |
| Coding Update | Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products | 00.03.07an | | 4/1/2024 | | | 5/17/2024 | | | |