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NotificationsEculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®) for intravenous  administration08.00.84j5/21/2024 10:00 AM8/19/20245/21/2024Medical Necessity Criteria
NotificationseviCore Lab Management (AmeriHealth)06.02.52ag5/31/2024 11:00 AM7/1/20245/31/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsMultiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services00.01.68b5/31/2024 2:00 PM7/1/20245/31/2024Coverage and/or Reimbursement Position
New PoliciesAuricular Prostheses05.00.825/20/20245/20/2024This is a New Policy.
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25bn4/1/20245/1/2024Coverage and/or Reimbursement Position5/1/2024
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25bn4/1/20245/3/2024Coverage and/or Reimbursement Position
Updated PoliciesBotulinum Toxin Agents08.00.26ac5/6/20245/6/2024Medical Necessity Criteria
Updated PoliciesExperimental/Investigational Services12.01.01bl4/1/20245/6/2024Medical Coding
Updated PoliciesDurvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)08.01.65d5/6/20245/6/2024Medical Necessity Criteria
Updated PoliciesMirvetuximab soravtansine-gynx (Elahere™)08.02.01b5/20/20245/20/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesMogamulizumab-kpkc (Poteligeo®)08.01.52f5/20/20245/20/2024Medical Necessity Criteria
Updated PoliciesAmivantamab-vmjw (Rybrevant®)08.01.90a5/20/20245/20/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesEvinacumab-dgnb (Evkeeza®) 08.01.76c4/24/2024 10:00 AM5/27/20245/28/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Reissue PoliciesReimbursement for Components of Comprehensive Laboratory Panels00.01.61a6/15/20205/1/20245/1/2024
Reissue PoliciesSeat Lift Mechanisms05.00.43h4/13/20235/1/20245/1/2024
Reissue PoliciesSpinal Decompression with Interspinous and Interlaminar Devices11.14.22d1/1/20175/1/20245/1/2024
Reissue PoliciesHigh-Frequency Chest Wall Oscillation Devices05.00.14p7/31/20235/1/20245/1/2024
Reissue PoliciesPhotodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)07.00.10j7/3/20235/1/20245/1/2024
Reissue PoliciesExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)08.01.34c10/1/20215/1/20245/1/2024
Reissue PoliciesDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty11.16.01k9/25/20235/1/20245/1/2024
Reissue PoliciesDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails11.08.17k10/1/20215/1/20245/1/2024
Reissue PoliciesElectroconvulsive Therapy (ECT)14.00.01a10/1/20235/1/20245/1/2024
Reissue PoliciesAllergy Immunotherapy07.00.21j1/1/20215/1/20245/1/2024
Reissue PoliciesBurosumab-twza (Crysvita®)08.01.49b3/15/20215/1/20245/1/2024
Reissue PoliciesIntravenous Chelation Therapy07.00.02j10/1/20235/1/20245/1/2024
Reissue PoliciesAlpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)08.00.91e1/4/20215/1/20245/1/2024
Reissue PoliciesEvaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)07.03.15d6/28/20175/1/20245/1/2024
Reissue PoliciesScreening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA)09.00.40d2/18/20165/1/20245/1/2024
Reissue PoliciesBone Mineral Density (BMD) Testing09.00.04o1/2/20245/1/20245/1/2024
Reissue PoliciesVentricular Assist Devices (VADs)11.02.16u5/29/20235/1/20245/1/2024
Reissue PoliciesPatient Lifts05.00.42i5/22/20235/1/20245/1/2024
Reissue PoliciesBilling Requirements for Multiple Births for Professional Providers00.10.38a12/30/20195/15/20245/15/2024
Reissue PoliciesInstrument-Based Vision Screening07.13.12d1/1/20165/15/20245/15/2024
Reissue PoliciesComplementary and Integrative Health Services12.00.03h4/1/20245/15/20245/15/2024
Reissue PoliciesBronchial Valves11.16.094/1/20225/15/20245/15/2024
Reissue PoliciesHigh Osmolar Contrast Agents09.00.13c12/30/20155/15/20245/15/2024
Reissue PoliciesVoretigene Neparvovec-rzyl (Luxturna®)08.01.44c1/1/20195/15/20245/15/2024
Reissue PoliciesBelimumab (Benlysta®) for Intravenous Use08.00.99e10/24/20225/15/20245/15/2024
Reissue PoliciesPositron Emission Mammography (PEM)09.00.51a11/6/20135/15/20245/15/2024
Reissue PoliciesPsychological Testing14.00.021/1/20235/15/20245/15/2024
Reissue PoliciesConsultation Services00.01.69b1/1/20235/15/20245/15/2024
Reissue PoliciesNucleoplasty11.15.19e5/7/20145/29/20245/29/2024
Reissue PoliciesTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.74i10/1/20235/29/20245/29/2024
Reissue PoliciesNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)05.00.73g7/31/20235/29/20245/29/2024
Reissue PoliciesPersonalized Vaccines (e.g., Provenge®)08.00.95f12/20/20215/29/20245/29/2024
Reissue PoliciesAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma11.05.16l1/1/20235/29/20245/29/2024
Reissue PoliciesMechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures05.00.70c4/11/20225/29/20245/29/2024
Reissue PoliciesPercutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)05.00.75a4/24/20235/29/20245/29/2024
Reissue PoliciesEvaluation and Treatment of Erectile Dysfunction (ED)11.11.01k1/2/20245/29/20245/29/2024
Reissue Policiescrizanlizumab-tmca (Adakveo®)08.00.04a10/1/20235/29/20245/29/2024
Reissue PoliciesRemoval of Breast Implants11.08.14n6/5/20235/29/20245/29/2024
Reissue PoliciesRozanolixizumab-noli (Rystiggo)08.02.08a1/1/20245/29/20245/29/2024
Reissue PoliciesMaintenance Treatment of Opioid or Alcohol Use Disorder 08.01.37c4/10/20235/29/20245/29/2024
Reissue PoliciesGenetic Testing (AmeriHealth Administrators)06.02.35an4/1/20245/29/20245/29/2024
Reissue PoliciesGenetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)06.02.06r10/1/20215/29/20245/29/2024
Reissue PoliciesGenetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (AmeriHealth Administrators)06.02.10r1/1/20215/29/20245/29/2024
Reissue PoliciesMeasurement of Serum Antibodies to and Measurement of Serum Levels of Biologics06.02.39d1/1/20205/29/20245/29/2024
Reissue PoliciesGivosiran (Givlaari)08.00.215/2/20225/29/20245/30/2024
Coding UpdateElective Abortion11.06.02m4/1/20245/1/20245/1/2024
Coding UpdateElective Abortion11.06.02m4/1/20245/1/2024
Coding UpdateDurable Medical Equipment (DME) and Consumable Medical Supplies05.00.21ad4/1/20245/3/20245/3/2024
Coding UpdateDurable Medical Equipment (DME) and Consumable Medical Supplies05.00.21ad4/1/20245/6/2024
Coding UpdateGenetic Testing (AmeriHealth Administrators)06.02.35an4/1/20245/7/2024
Coding UpdateeviCore Lab Management (AmeriHealth)06.02.52af4/1/20245/7/2024
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products00.03.07an4/1/20245/17/2024