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News & Announcements7/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products7/2/2021
News & AnnouncementsADUHELM™ (aducanumab-avwa) injection (for Commercial Members)7/6/2021
News & AnnouncementsPreventive Coverage of Colorectal Cancer Screening for AmeriHealth Members7/26/2021
NotificationsRadiation Therapy Services (AmeriHealth)09.00.56l7/1/2021 10:00 AM8/1/20217/1/2021General Description, Guidelines, or Informational Update
NotificationsAnkle-Foot/Knee-Ankle-Foot Orthoses05.00.39r7/2/2021 7:00 AM8/2/20217/2/2021Coverage and/or Reimbursement Position
NotificationsKnee Orthoses05.00.47p7/2/2021 7:00 AM8/2/20217/2/2021Coverage and/or Reimbursement Position
NotificationsOmalizumab (Xolair®)08.00.55i7/6/2021 1:00 PM10/4/20217/6/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®)08.01.23i7/6/2021 1:00 PM10/4/20217/6/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria
NotificationsTelemedicine Services (AmeriHealth)00.10.41i7/2/2021 4:00 PM10/1/20217/21/20217/21/2021Medical Necessity Criteria;Medical Coding7/21/2021
New PoliciesDostarlimab-gxly (Jemperli)08.01.797/12/20217/12/2021This is a New Policy.
Updated PoliciesTelemedicine Services (AmeriHealth)00.10.41h4/1/2021 3:00 PM7/1/20217/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update7/20/2021
Updated PoliciesPreventive Care Services00.06.02af7/1/20217/1/2021Medical Necessity Criteria;Medical Coding
Updated PoliciesImmunizations08.01.04x7/1/20217/1/2021Medical Necessity Criteria
Updated PoliciesSpinal Discectomy (Amerihealth Administrators)11.14.29h4/1/2021 11:00 AM7/1/20217/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PolicieseviCore Lab Management (AmeriHealth)06.02.52u6/2/2021 3:00 PM7/1/20217/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria
Updated PoliciesTocilizumab (Actemra®) for Intravenous Infusion08.00.85l7/1/20217/1/2021Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)08.01.33d7/1/20217/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25bd7/1/20217/1/2021Coverage and/or Reimbursement Position
Updated PoliciesNew Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances00.01.55r7/1/20217/1/2021Coverage and/or Reimbursement Position
Updated PoliciesRoutine Costs Associated with Qualifying Clinical Trials07.00.20g4/6/2021 2:00 PM7/5/20217/5/2021General Description, Guidelines, or Informational Update
Updated PoliciesVedolizumab (Entyvio®)08.01.18f7/12/20217/12/2021Medical Necessity Criteria;Medical Coding
Updated PoliciesTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.74f6/10/2021 2:00 PM7/12/20217/12/2021Medical Necessity Criteria
Updated PoliciesExperimental/Investigational Services12.01.01ba4/12/2021 12:00 PM7/12/20217/12/2021Coverage and/or Reimbursement Position;Medical Coding7/12/2021
Updated PoliciesEnfortumab vedotin-ejfv (Padcev®)08.00.43b6/4/2021 1:00 PM7/12/20217/12/2021Medical Necessity Criteria
Updated PoliciesModifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period03.00.15p7/12/20217/12/2021General Description, Guidelines, or Informational Update
Updated PoliciesMarijuana for Medical Use00.01.48d7/12/20217/12/2021General Description, Guidelines, or Informational Update
Updated PoliciesX-rays Associated with Fractures in the Office Setting00.03.09e7/19/20217/19/2021General Description, Guidelines, or Informational Update
Updated PoliciesReimbursement for the Administration of Drugs, Substances, and/or Biologic Agents00.10.43a7/19/20217/19/2021Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesPercutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery11.02.12j7/19/20217/19/2021Coverage and/or Reimbursement Position;Medical Coding
Reissue PoliciesAlemtuzumab (Lemtrada®)08.01.22d5/4/20206/30/20217/1/2021
Reissue PoliciesPediatric Intensive Day Feeding Program10.00.031/28/20196/30/20217/1/2021
Reissue PoliciesDay Rehabilitation10.00.02c1/13/20206/30/20217/1/2021
Reissue PoliciesPulmonary Rehabilitation10.04.01l12/30/20196/30/20217/1/2021
Reissue PoliciesTopical Oxygenation07.00.09d4/8/20156/30/20217/1/2021
Reissue PoliciesHospital Beds and Accessories05.00.56j10/12/20206/30/20217/1/2021
Reissue PoliciesPressure-Reducing Support Surfaces05.00.60i11/9/20206/30/20217/1/2021
Reissue PoliciesMedical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD)07.03.03g7/15/20196/30/20217/2/2021
Reissue PoliciesObsolete or Unreliable Diagnostic Tests and Medical Services00.01.24h5/6/20196/30/20217/2/2021
Reissue PoliciesPanniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin11.08.06j10/1/20187/14/20217/19/2021
Coding UpdateMargetuximab-cmkb (Margenza)08.01.75a7/1/20217/1/2021
Coding UpdateTrilaciclib (Cosela™)08.01.77a7/1/20217/1/2021
Coding Updateevinacumab-dgnb (Evkeeza) 08.01.76a7/1/20217/1/2021
Coding UpdateColorectal Cancer Screening11.03.12t7/1/20217/1/2021
Coding UpdateNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease06.02.56d7/1/20217/1/2021
Coding UpdateGenetic Testing (AmeriHealth Administrators)06.02.35ac7/1/20217/1/2021
Coding UpdateChimeric Antigen Receptor (CAR) Therapy08.01.43h7/1/20217/1/2021
Coding UpdateModifiers 26 (Professional Component) and TC (Technical Component)03.00.20m7/1/20217/1/2021
Coding UpdateModifier 50: Bilateral Procedure03.00.05q7/1/20217/1/2021
Coding UpdateReimbursement for Radiopharmaceutical Agents for Professional Providers09.00.32x7/1/20217/1/2021
Coding UpdateMelphalan flufenamide (Pepaxto®)08.01.78a7/1/20217/1/2021
Coding UpdateRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)08.00.50x7/1/20217/1/2021
Coding UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21g7/1/20217/1/2021
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS00.10.18p7/1/20217/1/2021
Coding UpdateModifier 62: Two Surgeons00.10.11q7/1/20217/1/2021
Coding UpdateModifier 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 Service03.00.06u7/1/20217/1/2021
Coding UpdateAlways Bundled Procedure Codes00.01.52m7/1/20217/6/2021
Coding UpdateTesting Serum Vitamin D Levels06.02.51d10/1/20207/14/20217/14/2021