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News & AnnouncementsNotification of Upcoming Changes to Temporary COVID-19 Waivers of Certain Requirements for Respiratory Equipment/Related Supplies AND DME/POS 6/4/2021
News & AnnouncementsNotification of Upcoming Changes to Pharmacologic Nuclear Stress Testing in response to COVID-196/15/2021
NotificationsMultiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services00.01.60f6/1/2021 1:00 PM9/1/20216/1/2021Coverage and/or Reimbursement Position
NotificationseviCore Lab Management (AmeriHealth)06.02.52u6/2/2021 3:00 PM7/1/20216/2/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria
NotificationsEnfortumab vedotin-ejfv (Padcev®)08.00.43b6/4/2021 1:00 PM7/12/20216/4/2021Medical Necessity Criteria
NotificationsEvaluation and Treatment of Erectile Dysfunction (ED)11.11.01j6/8/2021 11:00 AM9/13/20216/8/2021Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.74f6/10/2021 2:00 PM7/12/20216/10/2021Medical Necessity Criteria
NotificationsHigh-Technology Radiology Services09.00.46ag6/14/2021 2:00 PM9/12/20216/14/2021General Description, Guidelines, or Informational Update
Updated PoliciesSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence11.17.04t6/7/20216/7/2021Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesEnzyme Replacement for the Treatment of Gaucher's Disease08.00.51k6/7/20216/7/2021Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)05.00.73e6/7/20216/7/2021Medical Necessity Criteria
Updated PoliciesBlinatumomab (Blincyto®)08.01.21d6/7/20216/7/2021Medical Necessity Criteria;Medical Coding
Updated PoliciesPolatuzumab Vedotin-Piiq (Polivy®)08.01.59c6/7/20216/7/2021Medical Necessity Criteria
Updated PoliciesDaratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)08.01.29i6/7/20216/7/2021Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesModifier 66: Surgical Team00.10.17l6/7/20216/7/2021Medical Coding;General Description, Guidelines, or Informational Update
Reissue PoliciesNeuropsychological Testing for Neurologically Based Conditions07.03.08j10/1/20206/2/20216/2/2021
Reissue PoliciesCataract Surgery11.01.07e1/1/20206/2/20216/2/2021
Reissue PoliciesImplantation of Intrastromal Corneal Ring Segments (ICRS)11.05.11c9/7/20166/2/20216/2/2021
Reissue PoliciesSurgical Correction of Strabismus11.05.07d9/7/20166/2/20216/2/2021
Reissue PoliciesUterine Artery Embolization11.06.04k5/20/20196/2/2021
Reissue PoliciesBone Mineral Density (BMD) Testing09.00.04k3/10/20206/2/2021
Reissue PoliciesEndometrial Ablation11.06.05f5/20/20196/2/2021
Reissue PoliciesExtracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions11.14.13g1/1/20176/2/20216/2/2021
Reissue PoliciesPhotodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])07.07.03m7/1/20196/2/20216/2/2021
Reissue PoliciesScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)07.13.06l9/30/20206/1/20216/2/2021
Reissue PoliciesRefractive Keratoplasty11.05.01f7/1/20196/2/20216/2/2021
Reissue PoliciesLaboratory-Based Vestibular Function Testing07.03.24b1/1/20216/2/20216/2/2021
Reissue PoliciesProcedures for the Treatment of Gastroesophageal Reflux Disease (GERD)11.03.11p12/7/20206/2/20216/2/2021
Reissue PoliciesGenetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)06.02.06q7/1/20206/2/20216/2/2021
Reissue PoliciesPreimplantation Genetic Testing (AmeriHealth Administrators)06.02.24j10/1/20166/2/20216/2/2021
Reissue PoliciesLow-level Laser Therapy (LLLT)07.00.14g9/30/20196/2/20216/3/2021
Reissue PoliciesShort-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)05.00.24r10/26/20206/2/20216/3/2021
Reissue PoliciesTreatment of Medical and Surgical Complications11.00.02f8/26/20156/2/20216/3/2021
Reissue PoliciesInsulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems05.00.79c10/26/20206/2/20216/3/2021
Reissue PoliciesSubcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia05.00.77b3/22/20216/2/20216/3/2021
Reissue PoliciesPharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (AmeriHealth Administrators)06.02.18l4/1/20206/2/20216/3/2021
Reissue PoliciesPresumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments06.02.44n1/1/20216/2/20216/3/2021
Reissue PoliciesTherapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics06.02.554/7/20176/2/20216/3/2021
Reissue PoliciesMagnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation11.06.06f1/1/20216/2/20216/3/2021
Reissue PoliciesEquipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes05.00.05m10/26/20206/2/20216/3/2021
Reissue PoliciesAcute Care Facility Inpatient Transfers12.04.04a12/30/20196/2/20216/3/2021
Reissue PoliciesHair Transplants and Cranial Prostheses (Wigs)11.08.01g9/9/20196/2/20216/3/2021
Reissue PoliciesPercutaneous Discectomy11.15.15g12/1/20176/2/20216/3/2021
Reissue PoliciesPatient Lifts05.00.42h2/15/20216/2/20216/4/2021
Reissue PoliciesOstomy Supplies05.00.50l8/3/20206/2/20216/4/2021
Reissue PoliciesTranscranial Magnetic Stimulation (TMS)07.03.22d7/1/20196/2/20216/4/2021
Reissue PoliciesChiropractic Spinal and Extraspinal Manipulation Therapy10.02.02j5/18/20206/2/20216/4/2021
Reissue PoliciesPharmacogenetic Testing to Determine Drug Sensitivity (AmeriHealth Administrators)06.02.30e7/1/20166/2/20216/4/2021
Reissue PoliciesReduction Mammoplasty11.08.02i1/1/20216/16/20216/16/2021
Reissue PoliciesHome-Based Sleep Studies07.03.01a10/1/20206/16/20216/16/2021
Reissue PoliciesMedical and Surgical Treatment of Temporomandibular Joint Disorder07.08.03g11/26/20206/16/20216/16/2021
Reissue PoliciesTrigger Point Injections11.14.02p11/27/20206/16/20216/16/2021
Reissue PoliciesGastric Electrical Stimulation (Enterra™), Gastric Pacing11.03.15i11/30/20206/16/20216/16/2021
Reissue PoliciesSurgery for Gynecomastia11.08.12h5/18/20166/16/20216/17/2021
Reissue PoliciesNucleoplasty11.15.19e5/7/20146/16/20216/17/2021
Reissue PoliciesMigraine Deactivation Surgery11.15.24a3/11/20156/16/20216/17/2021
Reissue PoliciesPhotodynamic Therapy (PDT) Using Verteporfin (Visudyne®)07.13.05k5/7/20186/16/20216/17/2021
Reissue PoliciesSurgical Treatments of Athletic Pubalgia11.14.26a6/3/20156/16/20216/17/2021
Reissue PoliciesWireless Capsule Endoscopy (WCE) as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon07.05.02n12/16/20166/16/20216/17/2021
Reissue PoliciesAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma11.05.16i11/30/20206/16/20216/17/2021
Reissue PoliciesLysis of Epidural Adhesions11.15.13d2/14/20166/16/20216/17/2021
Reissue PoliciesMentoplasty or Genioplasty11.14.01g6/25/20176/16/20216/17/2021
Reissue PoliciesStem-Cell Therapy for Orthopedic Applications and Autologous Platelet-Derived Growth Factors (PDGFs)/Platelet-Rich Plasmas (PRPs) for Acute or Chronic Wound Healing and Other Miscellaneous Conditions07.07.09g12/30/20196/16/20216/17/2021
Reissue PoliciesVagus Nerve Stimulation (VNS)11.15.16p3/26/20216/16/20216/17/2021
Reissue PoliciesInjectable Dermal Fillers05.00.62h1/1/20176/16/20216/17/2021