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News & AnnouncementsCoverage of the COVID-19 Vaccination for AmeriHealth Members (Updated on June 19, 2023)6/19/2023
News & Announcements7/01/2023 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products6/30/2023
NotificationseviCore Lab Management (AmeriHealth)06.02.52ac6/1/2023 10:00 AM7/1/20236/1/2023Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsModifier 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 Service03.00.06x6/15/2023 2:00 PM10/2/20236/15/2023Coverage and/or Reimbursement Position;Medical Coding6/15/2023
NotificationsModifier 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 Service03.00.06x6/19/2023 2:00 PM10/2/20236/19/2023Coverage and/or Reimbursement Position;Medical Coding
NotificationsIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) inhibitors08.00.74s6/20/2023 9:00 AM9/18/20236/20/2023Medical Necessity Criteria
New PoliciesRetifanlimab-dlwr (Zynyz TM) 08.02.056/5/20236/5/2023This is a New Policy.
Updated PoliciesMonoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease08.01.93a6/5/20236/5/2023Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesSelf-Administered Drugs08.00.78am6/5/20236/5/2023Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesRemoval of Breast Implants11.08.14n6/5/20236/5/2023Coverage and/or Reimbursement Position;Medical Coding;General Description, Guidelines, or Informational Update
Updated Policiespatisiran (Onpattro®) and vutrisiran (Amvuttra™)08.01.50c3/14/2023 10:00 AM6/12/20236/12/2023Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesAsparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)08.01.35g6/19/20236/19/2023Medical Necessity Criteria;Medical Coding
Updated PoliciesTafasitamab-cxix (Monjuvi®) 08.01.81b6/19/20236/19/2023Medical Necessity Criteria;Medical Coding
Updated PoliciesMargetuximab-cmkb (Margenza)08.01.75c6/19/20236/19/2023Medical Necessity Criteria
Updated PoliciesOstomy Supplies05.00.50o6/30/20236/30/2023Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
Updated PoliciesInjectable Dermal Fillers for Cosmetic Procedures05.00.62i3/31/2023 1:00 PM7/1/20236/30/2023General Description, Guidelines, or Informational Update
Updated PoliciesPreventive Care Services00.06.02am7/1/20236/30/2023Medical Necessity Criteria;Medical Coding
Updated PoliciesReimbursement for the Administration of Drugs, Substances, and/or Biologic Agents00.10.43d7/1/20236/30/2023Medical Coding
Reissue PoliciesPercutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis11.15.22d1/1/20175/31/20236/1/2023
Reissue PoliciesAnifrolumab-fnia (Saphnelo®)08.01.82b4/1/20226/2/20236/2/2023
Reissue PoliciesDofetilide (Tikosyn®) Use in the Inpatient Setting08.00.49e9/26/20196/2/20236/2/2023
Reissue PoliciesHome-Based Sleep Studies07.03.01b10/1/20226/14/20236/14/2023
Reissue PoliciesAir Ambulance Services12.04.03c1/1/20196/14/20236/14/2023
Reissue PoliciesPersonalized Vaccines (e.g., Provenge®)08.00.95f12/20/20216/14/20236/14/2023
Reissue PoliciesSpesolimab--sbzo (Spevigo®)08.01.97a4/1/20236/14/20236/15/2023
Reissue PoliciesPhotodynamic Therapy (PDT) Using Verteporfin (Visudyne®)07.13.05k5/7/20186/14/20236/15/2023
Reissue PoliciesIntravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances00.01.451/8/20106/14/20236/15/2023
Reissue PoliciesInebilizumab-cdon (Uplizna)08.01.68b8/9/20216/14/20236/15/2023
Reissue PoliciesSkilled Nursing Facility (SNF): Skilled and Subacute Levels of Care02.03.0011/1/20206/14/20236/15/2023
Reissue PoliciesAutomatic External Cardioverter Defibrillators (Wearable and Nonwearable)05.00.29n11/21/20226/14/20236/15/2023
Reissue PoliciesColorectal Cancer Screening11.03.12t7/1/20216/14/20236/15/2023
Reissue PoliciesPhotodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])07.07.03m7/1/20196/14/20236/15/2023
Reissue PoliciesPercutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound  (AmeriHealth)11.02.27g1/1/20236/28/20236/28/2023
Reissue PoliciesOrthoptic/Pleoptic Training07.13.01j1/1/20236/28/20236/28/2023
Reissue PoliciesImplantation of Intrastromal Corneal Ring Segments (ICRS)11.05.11c9/7/20166/28/20236/28/2023
Reissue PoliciesEndovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aorto-Iliac Aneurysms, and Infrarenal Aortic Aneurysms11.02.10p1/1/20226/28/20236/29/2023
Reissue PoliciesOutpatient Physical Medicine, Rehabilitation, and Habilitation Services10.03.01n8/29/20226/28/20236/29/2023
Reissue PoliciesUterine Artery Embolization11.06.04k5/20/20196/28/20236/29/2023
Reissue PoliciesSpeech Therapy10.06.01l1/1/20206/28/20236/29/2023
Reissue PoliciesElectrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System (Amerihealth Administrators)05.00.09i1/10/20216/28/20236/29/2023
Reissue PoliciesSentinel Lymph Node Biopsy and Mapping11.07.02k1/1/20236/28/20236/29/2023
Reissue PoliciesParenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor07.10.04c2/22/20176/28/20236/29/2023
Reissue PoliciesIntra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis11.14.07x4/1/20216/28/20236/29/2023
Reissue PoliciesLaparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis11.06.106/6/20226/28/20236/29/2023
Reissue PoliciesProphylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy11.08.19p10/1/20226/28/20236/29/2023
Reissue PoliciesEndometrial Ablation11.06.05f5/20/20196/28/20236/29/2023
Reissue PoliciesRadium Ra 223 dichloride (Xofigo®) Injection (AmeriHealth Administrators)08.01.14e3/1/20196/28/20236/29/2023
Reissue PoliciesProton Beam Radiation Therapy09.00.49m7/5/20226/28/20236/29/2023
Reissue PoliciesComplete Decongestive Therapy (CDT)07.06.01b12/30/20136/28/20236/29/2023
Coding UpdatePresumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments06.02.44q7/1/20236/30/2023
Coding UpdateCoagulation Factors08.00.92af7/1/20236/30/2023
Coding UpdateImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13af7/1/20236/30/2023
Coding UpdateSelf-Administered Drugs08.00.78an7/1/20236/30/2023
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08m7/1/20236/30/2023
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20ag7/1/20236/30/2023
Coding UpdateInsertion of Implantable Infusion Pumps11.15.03n7/1/20236/30/2023
Coding UpdateMosunetuzumab-axgb (Lunsumio™)08.02.00a7/1/20236/30/2023
Coding UpdateUblituximab-xiiy (Briumvi TM) for intravenous use08.02.02a7/1/20236/30/2023
Coding UpdateMirvetuximab soravtansine-gynx (Elahere TM)08.02.01a7/1/20236/30/2023
Archived PoliciesLysis of Epidural Adhesions11.15.13d6/30/2023 12:00 PM7/31/20236/30/2023