| News & Announcements | 7/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | | | | | | 7/2/2021 | | | |
| News & Announcements | ADUHELM™ (aducanumab-avwa) injection (for Commercial Members) | | | | | | 7/6/2021 | | 8/11/2021 | |
| News & Announcements | Preventive Coverage of Colorectal Cancer Screening for AmeriHealth Members | | | | | | 7/26/2021 | | | |
| Notifications | Radiation Therapy Services (AmeriHealth) | 09.00.56l | 7/1/2021 10:00 AM | 8/1/2021 | | | 7/1/2021 | General Description, Guidelines, or Informational Update | | |
| Notifications | Ankle-Foot/Knee-Ankle-Foot Orthoses | 05.00.39r | 7/2/2021 7:00 AM | 8/2/2021 | | | 7/2/2021 | Coverage and/or Reimbursement Position | | |
| Notifications | Knee Orthoses | 05.00.47p | 7/2/2021 7:00 AM | 8/2/2021 | | | 7/2/2021 | Coverage and/or Reimbursement Position | | |
| Notifications | Omalizumab (Xolair®) | 08.00.55i | 7/6/2021 1:00 PM | 10/4/2021 | | | 7/6/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Notifications | Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®) | 08.01.23i | 7/6/2021 1:00 PM | 10/4/2021 | | | 7/6/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria | | |
| New Policies | Dostarlimab-gxly (Jemperli) | 08.01.79 | | 7/12/2021 | | | 7/12/2021 | This is a New Policy. | | |
| Updated Policies | Telemedicine Services (AmeriHealth) | 00.10.41h | 4/1/2021 3:00 PM | 7/1/2021 | | | 7/1/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | 8/6/2021 | |
| Updated Policies | Preventive Care Services | 00.06.02af | | 7/1/2021 | | | 7/1/2021 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Immunizations | 08.01.04x | | 7/1/2021 | | | 7/1/2021 | Medical Necessity Criteria | | |
| Updated Policies | Spinal Discectomy (Amerihealth Administrators) | 11.14.29h | 4/1/2021 11:00 AM | 7/1/2021 | | | 7/1/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | eviCore Lab Management (AmeriHealth) | 06.02.52u | 6/2/2021 3:00 PM | 7/1/2021 | | | 7/1/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria | | |
| Updated Policies | Tocilizumab (Actemra®) for Intravenous Infusion | 08.00.85l | | 7/1/2021 | | | 7/1/2021 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Gonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®) | 08.01.33d | | 7/1/2021 | | | 7/1/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services | 00.01.25bd | | 7/1/2021 | | | 7/1/2021 | Coverage and/or Reimbursement Position | | |
| Updated Policies | New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances | 00.01.55r | | 7/1/2021 | | | 7/1/2021 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Routine Costs Associated with Qualifying Clinical Trials | 07.00.20g | 4/6/2021 2:00 PM | 7/5/2021 | | | 7/5/2021 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Vedolizumab (Entyvio®) | 08.01.18f | | 7/12/2021 | | | 7/12/2021 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies | 05.00.74f | 6/10/2021 2:00 PM | 7/12/2021 | | | 7/12/2021 | Medical Necessity Criteria | | |
| Updated Policies | Experimental/Investigational Services | 12.01.01ba | 4/12/2021 12:00 PM | 7/12/2021 | | | 7/12/2021 | Coverage and/or Reimbursement Position;Medical Coding | 7/12/2021 | |
| Updated Policies | Enfortumab vedotin-ejfv (Padcev®) | 08.00.43b | 6/4/2021 1:00 PM | 7/12/2021 | | | 7/12/2021 | Medical Necessity Criteria | | |
| Updated Policies | Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period | 03.00.15p | | 7/12/2021 | | | 7/12/2021 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Marijuana for Medical Use | 00.01.48d | | 7/12/2021 | | | 7/12/2021 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | X-rays Associated with Fractures in the Office Setting | 00.03.09e | | 7/19/2021 | | | 7/19/2021 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents | 00.10.43a | | 7/19/2021 | | | 7/19/2021 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery | 11.02.12j | | 7/19/2021 | | | 7/19/2021 | Coverage and/or Reimbursement Position;Medical Coding | | |
| Updated Policies | Radiation Therapy Services (AmeriHealth) | 09.00.56l | 7/1/2021 10:00 AM | 8/1/2021 | | | 7/30/2021 | General Description, Guidelines, or Informational Update | | |
| Reissue Policies | Alemtuzumab (Lemtrada®) | 08.01.22d | | 5/4/2020 | 6/30/2021 | | 7/1/2021 | | | |
| Reissue Policies | Pediatric Intensive Day Feeding Program | 10.00.03 | | 1/28/2019 | 6/30/2021 | | 7/1/2021 | | | |
| Reissue Policies | Day Rehabilitation | 10.00.02c | | 1/13/2020 | 6/30/2021 | | 7/1/2021 | | | |
| Reissue Policies | Pulmonary Rehabilitation | 10.04.01l | | 12/30/2019 | 6/30/2021 | | 7/1/2021 | | | |
| Reissue Policies | Topical Oxygenation | 07.00.09d | | 4/8/2015 | 6/30/2021 | | 7/1/2021 | | | |
| Reissue Policies | Hospital Beds and Accessories | 05.00.56j | | 10/12/2020 | 6/30/2021 | | 7/1/2021 | | | |
| Reissue Policies | Pressure-Reducing Support Surfaces | 05.00.60i | | 11/9/2020 | 6/30/2021 | | 7/1/2021 | | | |
| Reissue Policies | Medical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD) | 07.03.03g | | 7/15/2019 | 6/30/2021 | | 7/2/2021 | | | |
| Reissue Policies | Obsolete or Unreliable Diagnostic Tests and Medical Services | 00.01.24h | | 5/6/2019 | 6/30/2021 | | 7/2/2021 | | | |
| Reissue Policies | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 11.08.06j | | 10/1/2018 | 7/14/2021 | | 7/19/2021 | | | |
| Reissue Policies | Routine Foot Care for Certain Medical Conditions | 07.07.01p | | 10/1/2020 | 7/28/2021 | | 7/28/2021 | | | |
| Reissue Policies | Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices | 05.00.30m | | 10/1/2019 | 7/28/2021 | | 7/29/2021 | | | |
| Reissue Policies | Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®) | 08.01.41c | | 3/11/2019 | 7/28/2021 | | 7/29/2021 | | | |
| Reissue Policies | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™) | 08.01.71 | | 11/30/2020 | 7/28/2021 | | 7/30/2021 | | | |
| Reissue Policies | Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis | 11.14.07x | | 4/1/2021 | 7/28/2021 | | 7/30/2021 | | | |
| Reissue Policies | Eptinezumab-jjmr (VYEPTI™) | 08.00.45b | | 10/1/2020 | 7/28/2021 | | 7/30/2021 | | | |
| Reissue Policies | Total Artificial Hearts (TAHs) | 11.02.19f | | 1/1/2019 | 7/28/2021 | | 7/30/2021 | | | |
| Coding Update | Margetuximab-cmkb (Margenza) | 08.01.75a | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Trilaciclib (Cosela™) | 08.01.77a | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | evinacumab-dgnb (Evkeeza) | 08.01.76a | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Colorectal Cancer Screening | 11.03.12t | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease | 06.02.56d | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Genetic Testing (AmeriHealth Administrators) | 06.02.35ac | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Chimeric Antigen Receptor (CAR) Therapy | 08.01.43h | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Modifiers 26 (Professional Component) and TC (Technical Component) | 03.00.20m | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Modifier 50: Bilateral Procedure | 03.00.05q | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Reimbursement for Radiopharmaceutical Agents for Professional Providers | 09.00.32x | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Melphalan flufenamide (Pepaxto®) | 08.01.78a | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®) | 08.00.50x | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | 07.02.21g | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 00.10.18p | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Modifier 62: Two Surgeons | 00.10.11q | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Modifier 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 Service | 03.00.06u | | 7/1/2021 | | | 7/1/2021 | | | |
| Coding Update | Always Bundled Procedure Codes | 00.01.52m | | 7/1/2021 | | | 7/6/2021 | | | |
| Coding Update | Testing Serum Vitamin D Levels | 06.02.51d | | 10/1/2020 | | | 7/14/2021 | | 7/14/2021 | |