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News & AnnouncementsConsumer Grade Pulse Oximetry Devices For Use In The Home Setting (Updated October 01, 2021)10/1/2021
News & Announcements10/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products10/1/2021
News & AnnouncementsCoverage of the COVID-19 Vaccination for AmeriHealth Members (Updated October 15, 2021)10/15/2021
NotificationsPreventive Care Services (AmeriHealth)00.06.02ah10/1/2021 3:00 PM1/1/202210/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria
NotificationsExperimental/Investigational Services12.01.01bc10/11/2021 12:00 PM1/10/202210/11/2021Medical Coding
New PoliciesTafasitamab-cxix (Monjuvi®) 08.01.8110/11/202110/11/2021This is a New Policy.
Updated PoliciesRadiation Therapy Services (AmeriHealth)09.00.56m8/31/2021 9:00 AM10/1/202110/1/2021Medical Necessity Criteria
Updated PoliciesRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)08.00.50y10/1/202110/1/2021Medical Necessity Criteria;Medical Coding
Updated PoliciesInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®)08.01.23i7/6/2021 1:00 PM10/4/202110/4/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria
Updated PoliciesImmunizations08.01.04y10/11/202110/11/2021Medical Necessity Criteria
Updated PoliciesAlglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )08.00.72i10/11/202110/11/2021Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)07.13.06m10/11/202110/11/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
Updated PoliciesExperimental/Investigational Services12.01.01bb10/1/202110/11/2021Medical Coding
Updated PoliciesAlways Bundled Procedure Codes00.01.52n10/11/202110/11/2021Medical Coding
Updated PoliciesCoagulation Factors 08.00.92ad10/25/202110/25/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesSelf-Administered Drugs08.00.78ai10/25/202110/25/2021Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)08.01.33f10/25/202110/25/2021Medical Necessity Criteria
Updated PoliciesOctreotide Acetate (Sandostatin® LAR Depot)08.01.10g10/25/202110/25/2021Medical Necessity Criteria
Updated PoliciesModifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56)03.00.31g10/25/202110/25/2021Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
Updated PoliciesGuidelines for Home Care Visits Following Inpatient Maternity Stay00.05.01g10/25/202110/25/2021General Description, Guidelines, or Informational Update
Reissue PoliciesCoverage of Medical Devices05.00.04e11/4/201910/6/202110/6/2021
Reissue PoliciesArtificial Intervertebral Lumbar Disc Insertion11.15.311/10/202110/6/202110/6/2021
Reissue PoliciesBiofeedback Therapy07.00.01j10/1/202010/6/202110/6/2021
Reissue PoliciesOsteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound)05.00.811/10/202110/6/202110/6/2021
Reissue PoliciesWheelchair Cushions and Seating05.00.55i12/29/201710/6/202110/7/2021
Reissue PoliciesCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs10.01.01n10/1/201710/6/202110/7/2021
Reissue PoliciesSpinal Decompression with Interspinous and Interlaminar Devices11.14.22d1/1/201710/20/202110/20/2021
Reissue PoliciesSpinal Cord Ganglion and Dorsal Root Ganglion Stimulation (Amerihealth Administrators)11.15.01x1/10/202110/20/202110/20/2021
Reissue PoliciesElectrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System (Amerihealth Administrators)05.00.09i1/10/202110/20/202110/20/2021
Reissue PoliciesMeniscal Allograft Transplantation and Meniscal Implants (Amerihealth Administrators)11.14.03h1/10/202110/20/202110/20/2021
Reissue PoliciesPercutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty (Amerihealth Administrators)11.14.10s1/10/202110/20/202110/20/2021
Reissue PoliciesOsteochondral Autograft Transplantation (Amerihealth Administrators)11.14.09h1/10/202110/20/202110/20/2021
Reissue PoliciesArtificial Intervertebral Cervical Disc Insertion (Amerihealth Administrators)11.14.19p1/10/202110/20/202110/20/2021
Reissue PoliciesDrug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies07.05.07d12/16/201910/20/202110/21/2021
Reissue PoliciesPhotodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)07.00.10i12/17/201810/20/202110/21/2021
Reissue PoliciesIntravenous Chelation Therapy07.00.02i3/4/201910/20/202110/21/2021
Coding UpdateTrigger Point Injections11.14.02q10/1/202110/1/2021
Coding UpdateDenervation of the Spinal Nerves for Chronic Pain (Amerihealth Administrators)11.15.09p10/1/202110/1/202110/1/2021
Coding UpdateBrentuximab Vedotin (Adcetris®)08.01.13f10/1/202110/1/2021
Coding UpdateBevacizumab (Avastin®) and Related Biosimilars For Oncologic Use08.00.66p10/1/202110/1/2021
Coding UpdateGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)08.01.33e10/1/202110/1/2021
Coding UpdateRoutine Foot Care for Certain Medical Conditions07.07.01q10/1/202110/1/2021
Coding UpdatePaclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension)08.00.90l10/1/202110/1/2021
Coding UpdatePembrolizumab (Keytruda®)08.01.63b10/1/202110/1/2021
Coding UpdateTrilaciclib (Cosela™)08.01.77b10/1/202110/1/2021
Coding UpdateTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.74g10/1/202110/1/2021
Coding UpdateHigh-Frequency Chest Wall Oscillation Devices05.00.14m10/1/202110/1/2021
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS00.10.18q10/1/202110/1/2021
Coding UpdateModifier 62: Two Surgeons00.10.11r10/1/202110/1/2021
Coding UpdatePreventive Care Services (AmeriHealth)00.06.02ag10/1/202110/1/2021
Coding UpdateHyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies11.00.13h10/1/202110/1/2021
Coding UpdateLower Limb Prostheses05.00.59k10/1/202110/1/2021
Coding UpdateContact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects07.13.11k10/1/202110/1/2021
Coding UpdateElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)07.03.09r10/1/202110/1/2021
Coding UpdateNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies07.03.18q10/1/202110/1/2021
Coding UpdateNeuropsychological Testing for Neurologically Based Conditions07.03.08k10/1/202110/1/2021
Coding UpdateDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails11.08.17k10/1/202110/1/2021
Coding UpdateUltraviolet Light Therapy for the Treatment of Dermatological Conditions07.07.02k10/1/202110/1/2021
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20y10/1/202110/1/2021
Coding UpdateElectromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter07.03.21l10/1/202110/1/2021
Coding Updateevinacumab-dgnb (Evkeeza) 08.01.76b10/1/202110/1/2021
Coding UpdateAcupuncture (AmeriHealth)12.00.01g10/1/202110/1/2021
Coding UpdateRemoval of Breast Implants11.08.14m10/1/202110/1/2021
Coding UpdateDostarlimab-gxly (Jemperli)08.01.79a10/1/202110/1/2021
Coding UpdateMelphalan flufenamide (Pepaxto®)08.01.78b10/1/202110/1/2021
Coding UpdateTreatment of Obstructive Sleep Apnea (OSA) and Primary Snoring11.00.06l10/1/202110/1/2021
Coding UpdateMultiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services00.01.60g10/1/202110/1/2021
Coding UpdateCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing06.02.54b10/1/202110/1/2021
Coding UpdateModifier 50: Bilateral Procedure03.00.05r10/1/202110/1/2021
Coding UpdateGenetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)06.02.06r10/1/202110/1/2021
Coding UpdateGenetic Testing (AmeriHealth Administrators)06.02.35ad10/1/202110/1/2021
Coding UpdatePresumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments06.02.44o10/1/202110/1/2021
Coding UpdateChimeric Antigen Receptor (CAR) Therapy08.01.43i10/1/202110/1/2021
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08f10/1/202110/1/2021
Coding UpdateNoninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (AmeriHealth Administrators)06.02.47e10/1/202110/1/2021
Coding UpdateExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)08.01.34c10/1/202110/1/2021
Coding UpdatePrescription Lenses and Visual Devices07.13.13e10/1/202110/1/2021
Coding UpdateReimbursement for Associated Services Performed in Conjunction with Dental Care00.01.18f10/1/202110/1/2021
Coding UpdateGenetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)06.02.06r10/1/202110/1/2021
Coding UpdateeviCore Lab Management (AmeriHealth)06.02.52v10/1/202110/4/2021
Coding UpdateDurable Medical Equipment (DME) and Consumable Medical Supplies05.00.21y10/1/202110/4/2021
Coding UpdateRepair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices05.00.44o10/1/202110/6/2021
Coding UpdatePPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25be10/1/202110/25/2021
Archived PoliciesPhotography, Including Documentation and Record-Keeping Photography, Whole Body Integumentary Photography, Dermoscopy, and Dermatoscopy07.07.05b10/8/2021 10:00 AM11/8/202110/8/2021