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News & Announcements10/1/2020 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products10/1/2020
News & AnnouncementsTesting for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for AmeriHealth New Jersey Members10/6/2020
News & AnnouncementsTesting for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) For AmeriHealth Pennsylvania Members10/6/2020
NotificationsTelemedicine Services (AmeriHealth Pennsylvania)00.10.41h10/2/2020 1:00 PM1/1/202110/2/2020Coverage and/or Reimbursement Position10/19/2020
NotificationsPressure-Reducing Support Surfaces05.00.60i10/9/2020 2:00 PM11/9/202010/9/2020Medical Necessity Criteria
NotificationsArtificial Intervertebral Cervical Disc Insertion (Amerihealth Administrators)11.14.19p10/12/2020 9:00 AM1/10/202110/12/2020Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsMusculoskeletal Services (AmeriHealth)00.01.66c10/12/2020 2:00 PM1/10/202110/12/2020Coverage and/or Reimbursement Position;Medical Coding
NotificationsArtificial Intervertebral Lumbar Disc Insertion11.15.3110/12/2020 2:00 PM1/10/202110/12/2020This is a New Policy.
NotificationsReimbursement for the Administration of Drugs, Substances, and/or Biologic Agents00.10.4310/19/2020 3:00 PM1/18/202110/19/2020This is a New Policy.
NotificationsReimbursement for an Intraocular Lens11.05.10c10/20/2020 2:00 PM1/18/202110/20/2020Medical Coding
New PoliciesBelantamab mafodotin-blmf (Blenrep)08.01.7010/12/202010/12/2020This is a New Policy.
Updated PoliciesRadiation Therapy Services (AmeriHealth)09.00.56k7/31/2020 12:00 AM10/1/202010/1/2020Coverage and/or Reimbursement Position
Updated PoliciesSelf-Administered Drugs08.00.78af 10/5/202010/5/2020Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesRadiologic Guidance and/or Supervision and Interpretation of a Procedure00.10.36r7/14/2020 12:00 AM10/12/202010/12/2020Medical Coding
Updated PoliciesImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13z10/12/202010/12/2020Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesHospital Beds and Accessories05.00.56j10/12/202010/12/2020Medical Necessity Criteria
Updated PoliciesUstekinumab (Stelara®)08.00.82l10/12/202010/12/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Reissue PoliciesUltraviolet Light Therapy for the Treatment of Dermatological Conditions07.07.02j10/1/201710/7/202010/7/2020
Reissue PoliciesObsolete or Unreliable Diagnostic Tests and Medical Services00.01.24h5/6/201910/7/202010/7/2020
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 Conditions07.07.09g1/1/202010/9/202010/7/2020
Reissue PoliciesLutathera® (Lutetium Lu 177 Dotatate) (AmeriHealth Administrators)08.01.577/1/201910/7/202010/7/2020
Reissue PoliciesRadium Ra 223 dichloride (Xofigo®) Injection (AmeriHealth Administrators)08.01.14e3/4/201910/7/202010/7/2020
Reissue PoliciesFrenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)11.03.05d4/29/201910/7/202010/7/2020
Reissue PoliciesAssisted Reproductive Technology for Infertility and Oocyte Cryopreservation07.10.06h1/1/202010/7/202010/9/2020
Reissue PoliciesMedical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD)07.03.03g7/15/201910/14/2020
Coding UpdateContact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects07.13.11j10/1/202010/1/2020
Coding UpdateCorneal Pachymetry Using Ultrasound07.13.07k10/1/202010/1/2020
Coding UpdateElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)07.03.09q10/1/202010/1/2020
Coding UpdateNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies07.03.18p10/1/202010/1/2020
Coding UpdateNeuropsychological Testing for Neurologically Based Conditions07.03.08j10/1/202010/1/2020
Coding UpdateScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)07.13.06l10/1/202010/1/2020
Coding UpdateInfliximab and Related Biosimilars08.00.34o10/1/202010/1/2020
Coding UpdateProcedures for the Treatment of Gastroesophageal Reflux Disease (GERD)11.03.11o10/1/202010/1/2020
Coding UpdateDaratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)08.01.29g10/1/202010/1/2020
Coding UpdateAbatacept (Orencia®) for Injection for Intravenous Use08.00.62k10/1/202010/1/2020
Coding UpdateEptinezumab-jjmr (VYEPTI™)08.00.45b10/1/202010/1/2020
Coding UpdateBiofeedback Therapy07.00.01j10/1/202010/1/2020
Coding UpdateDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails11.08.17j10/1/202010/1/2020
Coding UpdateHigh-Frequency Chest Wall Oscillation Devices05.00.14l10/1/202010/1/2020
Coding UpdateImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13y10/1/202010/1/2020
Coding UpdateInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)08.01.23g10/1/202010/2/2020
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20w10/1/202010/2/2020
Coding UpdateRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)08.00.50w10/1/202010/2/2020
Coding UpdateTocilizumab (Actemra®) for Intravenous Infusion08.00.85j10/1/202010/2/2020
Coding UpdateGolimumab (Simponi Aria®) Intravenous (IV) Injection08.01.15e10/1/202010/2/2020
Coding UpdatePrescription Lenses and Visual Devices07.13.13d10/1/202010/2/2020
Coding UpdateRepair and Replacement of Durable Medical Equipment (DME)05.00.44l10/1/202010/2/2020
Coding UpdatePreventive Care Services (AmeriHealth)00.06.02ad10/1/202010/2/2020
Coding UpdateDurable Medical Equipment (DME) and Consumable Medical Supplies05.00.21v10/1/202010/2/2020
Coding UpdateMedical and Surgical Treatment of Temporomandibular Joint Disorder07.08.03f10/1/202010/5/2020
Coding UpdateHome-Based Sleep Studies07.03.01a10/1/202010/6/2020
Coding UpdateNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)05.00.73d10/1/202010/6/2020
Coding UpdateTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.74e10/1/202010/6/2020
Coding UpdateRoutine Foot Care for Certain Medical Conditions07.07.01p10/1/202010/6/2020
Coding UpdateModifier 50: Bilateral Procedure03.00.05m10/1/202010/7/2020
Coding UpdateAlways Bundled Procedure Codes00.01.52j10/1/202010/7/2020
Coding UpdateDenosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity™)08.00.94n10/1/202010/8/2020
Coding UpdateSacituzumab govitecan-hziy (TrodelvyTM)08.01.60a10/1/202010/8/2020
Coding UpdateIsatuximab-irfc (Sarclisa®)08.00.46A10/1/202010/8/2020
Coding UpdatePemetrexed (Alimta®)08.00.87g10/1/202010/8/2020
Coding UpdateBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus00.10.39m10/1/202010/12/2020