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New PoliciesEladocagene exuparvovec-tneq (Kebilidi™)08.02.3711/13/20245/5/2025This is a New Policy.
New PoliciesImetelstat (Rytelo™)08.02.305/19/20255/19/2025This is a New Policy.
Updated PoliciesExperimental/Investigational Services12.01.01bp4/1/20255/5/2025Medical Coding
Updated PoliciesGivosiran (Givlaari) and Panhematin (Hemin)08.00.21a5/19/20255/19/2025Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesDostarlimab-gxly (Jemperli)08.01.79f5/19/20255/19/2025Medical Necessity Criteria
Reissue PoliciesHome Health Care Services02.01.01g1/6/20255/1/20255/1/2025
Reissue PoliciesHospice Care02.02.01h12/6/20215/14/20255/14/2025
Reissue PoliciesFrenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)11.03.05e1/1/20215/14/20255/14/2025
Reissue PoliciesSpinal Cord Ganglion and Dorsal Root Ganglion Stimulation (AmeriHealth Administrators)11.15.01y1/2/20245/14/20255/14/2025
Reissue PoliciesDenervation of the Spinal Nerves for Chronic Pain (Amerihealth Administrators)11.15.09r12/2/20245/14/20255/14/2025
Reissue PoliciesArtificial Intervertebral Cervical Disc Insertion (AmeriHealth Administrators)11.14.19p1/10/20215/14/20255/14/2025
Reissue PoliciesSpinal Laminectomy (Amerihealth Administrators)11.14.28e1/1/20225/14/20255/14/2025
Reissue PoliciesEnzyme Replacement for the Treatment of Gaucher's Disease08.00.51l1/1/20245/28/20255/28/2025
Reissue PoliciesRozanolixizumab-noli (Rystiggo)08.02.08a1/1/20245/28/20255/28/2025
Reissue PoliciesCrovalimab-akkz (Piasky)08.02.311/1/20255/28/20255/28/2025
Reissue PoliciesVelmanase alfa (Lamzede)08.02.043/11/20245/28/20255/28/2025
Reissue PoliciesReconstructive Breast Surgery and Post-Mastectomy Prostheses 11.08.15ac4/1/20255/28/20255/28/2025
Reissue PoliciesMargetuximab-cmkb (Margenza)08.01.75d6/19/20235/28/20255/28/2025
Reissue PoliciesPersonalized Vaccines (e.g., Provenge®)08.00.95f12/20/20215/28/20255/28/2025
Reissue PoliciesSpinal Fusion (Amerihealth Administrators)11.14.27f1/1/20225/28/20255/28/2025
Reissue PoliciesManipulation Under Anesthesia11.14.24b4/30/20185/28/20255/28/2025
Reissue PoliciesMigraine Deactivation Surgery11.15.24a3/11/20155/28/20255/28/2025
Reissue PoliciesSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence11.17.04y10/1/20245/28/20255/28/2025
Reissue PoliciesFecal Microbiota Transplantation (FMT)07.05.08d7/1/20235/28/20255/28/2025
Reissue PoliciesSecukinumab (Cosentyx®) for Intravenous Use08.02.288/26/20245/28/20255/28/2025
Reissue PoliciesTeplizumab-mzwv (Tzield)08.01.99b11/18/20245/28/20255/28/2025
Reissue PoliciesSpesolimab-sbzo (Spevigo®)08.01.97b8/12/20245/28/20255/28/2025
Reissue PoliciesInjectable Dermal Fillers for Cosmetic Procedures05.00.62i7/1/20235/28/20255/28/2025
Reissue PoliciesMentoplasty or Genioplasty11.14.01h10/1/20235/28/20255/28/2025
Reissue PoliciesLurbinectedin (Zepzelca®)08.01.67c5/8/20235/28/20255/28/2025
Reissue PoliciesIn Vitro Allergy Testing06.02.26e12/19/20225/28/20255/28/2025
Reissue PoliciesCanakinumab (Ilaris®)08.01.51c1/6/20255/28/20255/28/2025
Reissue PoliciesPozelimab-bbfg (Veopoz®)08.02.174/1/20245/28/20255/28/2025
Reissue PoliciesAnifrolumab-fnia (Saphnelo®)08.01.82c6/17/20245/28/20255/28/2025
Reissue PoliciesBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids11.01.06i4/22/20245/28/20255/28/2025
Reissue PoliciesFidanacogene elaparvovec-dzkt (Beqvez™)08.02.25a1/1/20255/28/20255/28/2025
Reissue PoliciesDelandistrogene moxeparvovec (delandistrogene moxeparvovec-rokl; Elevidys®)08.02.13a1/1/20255/28/20255/28/2025
Reissue PoliciesValoctocogene roxaparvovec-rvox (ROCTAVIAN™)08.02.09b7/15/20245/28/20255/28/2025
Reissue PoliciesBetibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]08.01.89a7/1/20245/28/20255/28/2025
Reissue PoliciesADAMTS13, recombinant-krhn (Adzynma)08.02.217/15/20245/28/20255/28/2025
Reissue PoliciesEptinezumab-jjmr (VYEPTI™)08.00.45e11/18/20245/28/20255/28/2025
Reissue PoliciesBurosumab-twza (Crysvita®)08.01.49b3/15/20215/28/20255/28/2025
Reissue PoliciesOstomy Supplies05.00.50o6/30/20235/28/20255/28/2025
Reissue PoliciesAgalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) 08.00.69d9/9/20245/28/20255/28/2025
Reissue PoliciesEndovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aorto-Iliac Aneurysms, and Infrarenal Aortic Aneurysms11.02.10p1/1/20225/28/20255/28/2025
Reissue PoliciesRhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty11.08.13h1/1/20255/28/20255/28/2025
Reissue PoliciesPercutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)05.00.75a4/24/20235/28/20255/28/2025
Reissue PoliciesCollagenase clostridium histolyticum (Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)08.01.7111/30/20205/28/20255/28/2025
Reissue PoliciesNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)05.00.73g7/31/20235/28/20255/28/2025
Reissue PoliciesBelimumab (Benlysta®) for Intravenous Use08.00.99e10/24/20225/28/20255/28/2025
Coding UpdateRapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic Disorders06.02.46a1/1/20245/16/2025
Coding UpdateeviCore Lab Management (AmeriHealth)06.02.52aj4/1/20255/27/2025
Archived PoliciesComplete Decongestive Therapy (CDT)07.06.01b5/5/2025 9:00 AM6/9/20255/15/2025
Archived PoliciesNational Correct Coding Initiative (NCCI) Code Pair Edits00.01.56b5/28/2025 1:00 PM6/30/20255/28/2025
Archived PoliciesRadioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (AmeriHealth Administrators)08.00.08k5/30/2025 9:00 AM7/1/20255/30/2025