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News & AnnouncementsCoverage of the COVID-19 Vaccination for AmeriHealth Members (Retroactively effective to October 12, 2022, issued November 2, 2022)11/2/2022
News & AnnouncementsLaboratory Testing, Vaccination, and Treatment for Monkeypox for AmeriHealth Members (Updated November 7, 2022)11/7/2022
NotificationsMaintenance Treatment of Opioid or Alcohol Use Disorder 08.01.37b11/1/2022 9:00 AM1/1/202311/1/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
NotificationsIntravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)08.01.80a11/1/2022 9:00 AM1/1/202311/1/2022General Description, Guidelines, or Informational Update
NotificationsMedical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD)07.03.03h11/1/2022 10:00 AM1/1/202311/1/2022General Description, Guidelines, or Informational Update
NotificationsTranscranial Magnetic Stimulation (TMS)07.03.22e11/1/2022 10:00 AM1/1/202311/1/2022Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsHome-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)05.00.69c11/1/2022 10:00 AM1/1/202311/1/2022General Description, Guidelines, or Informational Update
NotificationsPsychological Testing14.00.0211/1/2022 10:00 AM1/1/202311/1/2022This is a New Policy.
NotificationsCranial Electrotherapy Stimulation05.00.80c11/1/2022 10:00 AM1/1/202311/1/2022General Description, Guidelines, or Informational Update
NotificationsEvaluation and Management of Autism Spectrum Disorder (ASD)07.03.07y11/1/2022 10:00 AM1/1/202311/1/2022Medical Coding;General Description, Guidelines, or Informational Update
NotificationsApplied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)14.00.0311/1/2022 10:00 AM1/1/202311/1/2022This is a New Policy.
NotificationsAcute Care Facility Inpatient Transfers12.04.04b11/1/2022 11:00 AM1/1/202311/1/2022General Description, Guidelines, or Informational Update
NotificationsElectroconvulsive Therapy (ECT)14.00.0111/1/2022 12:00 PM1/1/202311/1/2022This is a New Policy.
NotificationsVagus Nerve Stimulation (VNS)11.15.16r11/1/2022 12:00 PM1/1/202311/1/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsDeep Brain Stimulation (DBS)11.15.20q11/1/2022 12:00 PM1/1/202311/1/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsTelemedicine Services00.10.41k11/1/2022 2:00 PM1/1/202311/1/2022Medical Necessity Criteria;Medical Coding
NotificationsPresumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments06.02.44p11/1/2022 2:00 PM1/1/202311/1/2022General Description, Guidelines, or Informational Update
NotificationsTherapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics06.02.55a11/1/2022 2:00 PM1/1/202311/1/2022General Description, Guidelines, or Informational Update
NotificationsPharmacogenetic Testing to Determine Drug Sensitivity (AmeriHealth Administrators)06.02.30f11/1/2022 2:00 PM1/1/202311/1/2022General Description, Guidelines, or Informational Update
NotificationsOstomy Supplies05.00.50n11/4/2022 9:00 AM12/5/202211/4/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsCochlear Implantation11.01.02q11/7/2022 10:00 AM11/7/202211/7/202211/7/2022Medical Coding
NotificationsNeuropsychological Testing for Neurologically Based Conditions07.03.08m11/7/2022 10:00 AM2/6/202311/7/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsEflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related biosimilars08.01.32i11/18/2022 9:00 AM12/19/202211/18/2022Medical Necessity Criteria
NotificationsIn Vitro Allergy Testing06.02.26e11/18/2022 10:00 AM12/19/202211/18/2022Medical Necessity Criteria
Updated PoliciesPemetrexed (Alimta®), Pemetrexed (Pemfexy™)08.00.87j10/7/2022 7:00 AM11/7/202211/7/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesCare Management and Care Planning Services00.01.59l10/7/2022 10:00 AM11/7/202211/7/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesServices Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers00.10.01ag11/7/202211/7/2022Coverage and/or Reimbursement Position
Updated PoliciesCarfilzomib (Kyprolis®)08.01.05i11/7/202211/7/2022Medical Necessity Criteria
Updated PoliciesNeuropsychological Testing for Neurologically Based Conditions07.03.08l10/1/202211/7/2022Medical Coding
Updated PoliciesReporting Requirements for Drugs and Biologics00.01.49e11/7/202211/7/2022Medical Coding
Updated PoliciesObsolete or Unreliable Diagnostic Tests and Not Medically Necessary Medical Services00.01.24i11/21/202211/21/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
Updated PoliciesFilgrastim (Neupogen ®) and Related Biosimilars, and tbo-filgrastim (Granix ®)08.01.73d11/21/202211/21/2022Medical Necessity Criteria
Updated PoliciesAutomatic External Cardioverter Defibrillators (Wearable and Nonwearable)05.00.29n11/21/202211/21/2022Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices07.02.09h11/21/202211/21/2022General Description, Guidelines, or Informational Update
Updated PoliciesFirst-Trimester Prenatal Screening for Fetal Aneuploidy Using Fetal Ultrasound Markers09.00.36m11/21/202211/21/2022Medical Coding
Updated PoliciesAprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)08.01.41d8/30/2022 10:00 AM11/29/202211/29/2022Medical Necessity Criteria
Reissue PoliciesHospice Care02.02.01h12/6/202111/2/202211/2/2022
Reissue PoliciesPhotodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)07.00.10i12/17/201811/2/202211/2/2022
Reissue PoliciesSentinel Lymph Node Biopsy and Mapping11.07.02j5/31/201911/2/202211/2/2022
Reissue PoliciesPrivate Duty Nursing02.01.02d1/18/202111/2/202211/2/2022
Reissue PoliciesUpper Limb Prostheses05.00.72f4/15/201911/2/202211/2/2022
Reissue PoliciesMultiple Surgery Payment Reduction11.00.10x1/1/202111/2/202211/3/2022
Reissue PoliciesAir Ambulance Services12.04.03c1/1/201911/2/202211/3/2022
Reissue PoliciesGround Ambulance Services (Emergency and Nonemergency) (AmeriHealth)12.04.02i1/1/202011/2/202211/3/2022
Reissue PoliciesEndometrial Ablation11.06.05f5/20/201911/2/202211/3/2022
Reissue PoliciesFacility Reporting of Observation Services00.01.19e1/4/202111/3/2022
Reissue PoliciesCoagulation Factors08.00.92ae10/25/202111/2/202211/3/2022
Reissue PoliciesOvarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome11.06.07d4/23/201811/2/202211/4/2022
Reissue PoliciesArtificial Intervertebral Lumbar Disc Insertion11.15.31a7/1/202211/16/202211/16/2022
Reissue PoliciesChiropractic Spinal and Extraspinal Manipulation Therapy10.02.02j5/18/202011/16/202211/16/2022
Reissue PoliciesAllergy Immunotherapy07.00.21j1/1/202111/16/202211/16/2022
Reissue PoliciesElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)07.03.09t10/1/202211/16/2022
Reissue PoliciesNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies07.03.18s10/1/202211/16/2022
Reissue PoliciesBlepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy11.05.02j1/18/202111/16/2022
Reissue PoliciesTreatments for Complex Regional Pain Syndrome (CRPS)08.00.57o9/28/202011/16/202211/16/2022
Reissue PoliciesReimbursement for the Administration of Immunizations07.00.15m12/7/202011/16/202211/16/2022
Reissue PoliciesShort-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)05.00.24r10/26/202011/16/202211/16/2022
Reissue PoliciesCataract Surgery11.01.07f1/1/202211/16/202211/16/2022
Reissue PoliciesCriteria for Reimbursement of Emergency Room Services00.10.03j3/23/202011/16/202211/16/2022
Reissue PoliciesDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty11.16.01i1/3/202211/16/202211/16/2022
Reissue PoliciesCosmetic Procedures12.01.03a11/19/202011/16/202211/16/2022
Reissue PoliciesDurable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum05.00.48k1/18/202111/16/202211/16/2022
Reissue PoliciesTreatment of Twin-Twin Transfusion Syndrome (TTTS)11.00.14f8/12/201911/16/202211/18/2022
Reissue PoliciesAssisted Reproductive Technology for Infertility and Oocyte Cryopreservation07.10.06i1/1/202111/16/202211/18/2022
Reissue PoliciesElective Abortion11.06.02j10/1/202211/16/202211/18/2022
Reissue PoliciesPatisiran (Onpattro™)08.01.50b10/1/201911/16/202211/22/2022
Reissue PoliciesProteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)06.02.43b2/1/20176/29/202211/22/2022
Reissue PoliciesMeasurement of Serum Antibodies to and Measurement of Serum Levels of Biologics06.02.39d1/1/20206/29/202211/22/2022
Reissue PoliciesTherapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)08.01.36e7/1/202011/16/202211/22/2022
Reissue PoliciesColorectal Cancer Screening11.03.12t7/1/202111/16/202211/22/2022
Reissue PoliciesExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)08.01.34c10/1/202111/16/202211/22/2022
Reissue PoliciesVoretigene Neparvovec-rzyl (Luxturna™)08.01.44c1/1/201911/16/202211/22/2022
Reissue PoliciesSurgery for Gynecomastia11.08.12h5/18/201611/30/2022
Reissue PoliciesScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)07.13.06m10/11/202111/30/202211/30/2022
Coding UpdateeviCore Lab Management (AmeriHealth)06.02.52z10/1/202211/16/2022
Coding UpdateCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing06.02.54c10/1/202211/22/2022
Coding UpdateNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease06.02.56g10/1/202211/29/2022