| News & Announcements | Coverage of the COVID-19 Vaccination for AmeriHealth Members (Updated November 3, 2021) | | | | | | 11/3/2021 | | | |
| Notifications | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 00.10.18r | 11/5/2021 2:00 PM | 2/14/2022 | | | 11/5/2021 | Coverage and/or Reimbursement Position | | |
| Notifications | Pegfilgrastim (Neulasta®) and related biosimilars | 08.01.32f | 11/9/2021 11:00 AM | 2/7/2022 | | | 11/9/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Notifications | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 08.00.18o | 11/19/2021 8:00 AM | 12/20/2021 | | | 11/19/2021 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | High-Technology Radiology Services | 09.00.46ah | | 11/7/2021 | | | 11/8/2021 | Medical Necessity Criteria | | |
| Updated Policies | Use of a Robotic-Assisted Surgical System | 11.00.18b | | 11/8/2021 | | | 11/8/2021 | Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 08.00.18n | | 10/1/2021 | | | 11/19/2021 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN) | 08.00.17i | | 11/22/2021 | | | 11/22/2021 | Medical Necessity Criteria | | |
| Updated Policies | Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents | 08.00.25m | 8/18/2021 1:00 PM | 11/22/2021 | | | 11/22/2021 | Medical Necessity Criteria | | |
| Updated Policies | Filgrastim (Neupogen ®) and Related Biosimilars, and tbo-filgrastim (Granix ®) | 08.01.73a | | 11/22/2021 | | | 11/22/2021 | Medical Necessity Criteria | | |
| Reissue Policies | Application and Removal of Tattoos | 11.08.05g | | 7/20/2012 | 10/20/2021 | | 11/2/2021 | | | |
| Reissue Policies | Deep Brain Stimulation (DBS) | 11.15.20p | | 1/25/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Islet Cell Transplantation | 11.04.01d | | 1/1/2020 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter | 07.03.21l | | 10/1/2019 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Photocoagulation of Macular Drusen | 11.05.08d | | 6/14/2017 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Amerihealth Administrators) | 11.14.06j | | 1/10/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Osteochondral Allograft Transplantation (Amerihealth Administrators) | 11.14.12f | | 1/10/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Spinal Discectomy (Amerihealth Administrators) | 11.14.29h | | 7/1/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Transcatheter Closure of Cardiac Septal Defects | 11.02.11g | | 11/17/2017 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions | 11.02.17f | | 3/26/2018 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Private Duty Nursing | 02.01.02d | | 1/18/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Spinal Fusion (Amerihealth Administrators) | 11.14.27e | | 1/10/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Spinal Laminectomy (Amerihealth Administrators) | 11.14.28d | | 1/10/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Surgical Treatment of Femoroacetabular Impingement (Amerihealth Administrators) | 11.14.23d | | 1/10/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | 00.09.01h | | 1/1/2021 | 11/3/2021 | | 11/3/2021 | | | |
| Reissue Policies | Radiofrequency Ablation and Cryosurgical Ablation of Lung Tumors | 11.00.16g | | 4/9/2018 | 11/3/2021 | | 11/4/2021 | | | |
| Reissue Policies | Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies | 11.00.13h | | 10/1/2021 | 11/3/2021 | | 11/5/2021 | | | |
| Reissue Policies | Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies | 07.05.06g | | 12/2/2019 | 11/3/2021 | | 11/5/2021 | | | |
| Reissue Policies | Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (AmeriHealth Administrators) | 08.00.08j | | 3/4/2019 | 11/3/2021 | | 11/5/2021 | | | |
| Reissue Policies | Genetic Testing (AmeriHealth Administrators) | 06.02.35ad | | 10/1/2021 | 11/3/2021 | | 11/5/2021 | | | |
| Reissue Policies | Testing Serum Vitamin D Levels | 06.02.51d | | 10/1/2020 | 11/3/2021 | | 11/5/2021 | | | |
| Reissue Policies | Voretigene Neparvovec-rzyl (Luxturna™) | 08.01.44c | | 1/1/2019 | 11/3/2021 | | 11/5/2021 | | | |
| Reissue Policies | Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth | 04.00.05d | | 3/26/2014 | 11/3/2021 | | 11/8/2021 | | | |
| Reissue Policies | Inpatient Hospital Readmission | 00.01.47c | | 1/15/2017 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Home Health Care Services | 02.01.01e | | 1/4/2021 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs) | 00.10.40d | | 9/23/2019 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | 11.05.02j | | 1/18/2021 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Denervation of the Spinal Nerves for Chronic Pain (Amerihealth Administrators) | 11.15.09p | | 10/1/2021 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Corneal Pachymetry Using Ultrasound | 07.13.07k | | 10/1/2020 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Prescription Lenses and Visual Devices | 07.13.13d | | 10/1/2021 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management (Amerihealth Administrators) | 11.15.23j | | 1/10/2021 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation | 07.10.06i | | 1/1/2021 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Orthoptic/Pleoptic Training | 07.13.01h | | 10/7/2019 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Repair of Cleft Lip, Cleft Nose, and/or Cleft Palate | 11.03.01f | | 12/21/2020 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Skilled Nursing Facility (SNF): Skilled and Subacute Levels of Care | 02.03.00 | | 11/1/2020 | 11/17/2021 | | 11/17/2021 | | | |
| Reissue Policies | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®) | 08.00.91e | | 1/4/2021 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Natalizumab (Tysabri®) | 08.00.64g | | 10/21/2019 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | 11.16.06j | | 1/1/2020 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects | 07.13.11k | | 10/1/2021 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Partial Coherence Interferometry | 07.13.08e | | 4/23/2018 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Smell and Taste Dysfunction Testing | 07.11.01c | | 5/7/2018 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Tumor Treating Fields | 07.03.26a | | 1/27/2020 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | 11.01.06e | | 6/17/2019 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Sentinel Lymph Node Biopsy and Mapping | 11.07.02j | | 5/31/2019 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Mohs' Micrographic Surgery | 11.08.23j | | 10/1/2018 | 11/17/2021 | | 11/18/2021 | | | |
| Reissue Policies | Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty | 11.08.13g | | 5/19/2017 | 11/17/2021 | | 11/19/2021 | | | |
| Reissue Policies | Orthognathic Surgery | 11.14.08d | | 6/30/2017 | 11/17/2021 | | 11/19/2021 | | | |
| Reissue Policies | Cervical Traction Devices for In-home Use | 05.00.61g | | 11/9/2020 | 11/17/2021 | | 11/19/2021 | | | |
| Reissue Policies | Procedures for the Treatment of Acne | 11.08.29e | | 10/1/2016 | 11/17/2021 | | 11/19/2021 | | | |
| Reissue Policies | Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD) | 05.00.69b | | 8/24/2016 | 11/17/2021 | | 11/19/2021 | | | |
| Reissue Policies | Cranial Electrotherapy Stimulation | 05.00.80a | | 1/1/2020 | 11/17/2021 | | 11/19/2021 | | | |
| Reissue Policies | Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT) | 05.00.75 | | 9/30/2014 | 11/17/2021 | | 11/19/2021 | | | |
| Reissue Policies | Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics | 06.02.39d | | 1/1/2020 | 11/3/2021 | | 11/30/2021 | | | |
| Reissue Policies | Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™) | 06.02.43b | | 2/1/2017 | 11/3/2021 | | 11/30/2021 | | | |
| Reissue Policies | Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45) | 08.01.34c | | 10/1/2021 | 11/3/2021 | | 11/30/2021 | | | |
| Coding Update | Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products | 00.03.07ad | | 10/1/2021 | | | 11/11/2021 | | | |
| Archived Policies | Bronchial Thermoplasty | 11.16.07b | 11/29/2021 2:00 PM | 1/3/2022 | | | 11/29/2021 | | | |