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News & AnnouncementsExpiration of Coverage for Consumer Grade Pulse Oximeters Effective January 1, 2022 for Commercial Members12/2/2021
News & AnnouncementsCoverage of Preventive Well Visits Performed Through Telemedicine  Response to COVID-19 for AmeriHealth New Jersey Members (Updated December 29, 2021)12/29/2021
News & AnnouncementsTelemedicine and Telehealth Services for AmeriHealth New Jersey Members (Updated January 1, 2022)12/31/2021
News & AnnouncementsCoverage of Speech Therapy Services Performed Through Telemedicine for AmeriHealth Members (Updated January 1, 2022) 12/31/2021
News & AnnouncementsPharmaceutical Treatments of COVID-19 for AmeriHealth Pennsylvania Members (Effective January 1, 2022)12/31/2021
News & AnnouncementsPharmaceutical Treatments of COVID-19 for ​AmeriHealth New Jersey Members (Effective January 1, 2022)12/31/2021
News & AnnouncementsCoverage of the COVID-19 Vaccination for AmeriHealth Members (Effective January 1, 2022)12/31/2021
News & AnnouncementsADUHELM™ (aducanumab-avwa) injection for Commercial Members (Updated January 1, 2022)12/31/2021
News & Announcements1/01/2022 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products12/31/2021
NotificationseviCore Lab Management (AmeriHealth)06.02.52w12/1/2021 9:00 AM1/1/202212/1/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsBreast Pumps05.00.76e12/17/2021 10:00 AM1/17/202212/17/2021Medical Necessity Criteria
NotificationsElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)07.03.09s12/20/2021 12:00 PM3/21/202212/20/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria
NotificationsNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies07.03.18r12/20/2021 12:00 PM3/21/202212/20/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria
NotificationsPertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)08.01.72a12/21/2021 7:00 AM3/21/202212/21/2021Medical Necessity Criteria
Notificationspegfilgrastim (Neulasta®) and related biosimilars08.01.32h12/31/2021 9:00 AM4/1/202212/31/2021Coverage and/or Reimbursement Position
NotificationsRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)08.00.50z12/31/2021 9:00 AM4/1/202212/31/2021Coverage and/or Reimbursement Position
New PoliciesTisotumab vedotin-tftv (Tivdak™)08.01.8312/20/202112/20/2021This is a New Policy.
New PoliciesPain Management of Peripheral Nerves by Injection07.03.279/27/2021 12:00 PM12/27/202112/27/2021This is a New Policy.
Updated PoliciesModifier 53: Discontinued Procedure03.00.33b12/6/202112/5/2021General Description, Guidelines, or Informational Update
Updated PoliciesSacituzumab govitecan-hziy (TrodelvyTM)08.01.60c12/6/202112/6/2021Medical Necessity Criteria;Medical Coding
Updated PoliciesCarfilzomib (Kyprolis®)08.01.05h12/6/202112/6/2021Medical Necessity Criteria;Medical Coding
Updated PoliciesAdo-Trastuzumab Emtansine (Kadcyla®)08.01.11g12/6/202112/6/2021Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesHospice Care02.02.01h12/6/202112/6/2021General Description, Guidelines, or Informational Update
Updated PoliciesModifier 52: Reduced Services03.00.32b12/6/202112/6/2021General Description, Guidelines, or Informational Update
Updated PoliciesEvaluation and Management of Autism Spectrum Disorder (ASD)07.03.07w12/6/202112/6/202112/6/2021Coverage and/or Reimbursement Position
Updated PoliciesOutpatient Physical Medicine, Rehabilitation, and Habilitation Services10.03.01m12/20/202112/20/202112/20/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
Updated PoliciesNutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk08.00.18o11/19/2021 8:00 AM12/20/202112/20/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesPaclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension)08.00.90m12/20/202112/20/2021Medical Necessity Criteria
Updated PoliciesPertuzumab (Perjeta®)08.01.07h12/20/202112/20/2021Medical Necessity Criteria;Medical Coding
Updated PoliciesWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20z12/20/202112/20/2021General Description, Guidelines, or Informational Update
Updated PoliciesInfliximab and Related Biosimilars08.00.34p12/20/202112/20/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesPersonalized Vaccines (e.g. Provenge®)08.00.95f12/20/202112/20/2021Medical Necessity Criteria
Updated PoliciesEnfortumab vedotin-ejfv (Padcev®)08.00.43c12/20/202112/20/2021Medical Necessity Criteria
Updated PolicieseviCore Lab Management (AmeriHealth)06.02.52w12/1/2021 9:00 AM1/1/202212/31/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesPreventive Care Services00.06.02ah10/1/2021 10:00 PM1/1/202212/31/2021Coverage and/or Reimbursement Position;Medical Necessity Criteria12/31/2021
Updated PoliciesDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty11.16.01i1/3/202212/31/2021Coverage and/or Reimbursement Position;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesIntraoperative Neurophysiological Monitoring (INM)07.03.14q1/3/202212/31/2021Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
Updated PoliciesNational Correct Coding Initiative (NCCI) Code Pair Edits00.01.56b1/3/202212/31/2021Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesReporting and Documentation Requirements for Anesthesia Services00.01.14s1/1/202212/31/2021Coverage and/or Reimbursement Position;Medical Coding
Reissue PoliciesCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing06.02.54b10/1/202111/17/202112/15/2021
Reissue PoliciesColorectal Cancer Screening11.03.12t7/1/202111/17/202112/15/2021
Reissue PoliciesPatisiran (Onpattro™)08.01.50b10/1/201911/17/202112/15/2021
Reissue PoliciesEsophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)07.02.22b10/1/202011/17/202112/15/2021
Reissue PoliciesTherapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)08.01.36e7/1/202011/17/202112/15/2021
Reissue PoliciesMeasurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders07.11.02f3/26/201811/17/202112/15/2021
Coding UpdatePulmonary Rehabilitation10.04.01m1/1/202212/31/2021
Coding UpdateSpinal Laminectomy (Amerihealth Administrators)11.14.28e1/1/20221/1/202212/31/2021
Coding UpdateSpinal Fusion (Amerihealth Administrators)11.14.27f1/1/20221/1/202212/31/2021
Coding UpdateMusculoskeletal Services (AmeriHealth)00.01.66e1/1/202212/31/2021
Coding UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21h1/1/202212/31/2021
Coding UpdateEndovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions11.02.17g1/1/20221/1/202212/31/2021
Coding UpdateBone Mineral Density (BMD) Testing09.00.04l1/1/202212/31/2021
Coding UpdateWireless Capsule Endoscopy (WCE) as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon07.05.02o1/1/202212/31/2021
Coding UpdateHigh-Technology Radiology Services09.00.46ai1/1/202212/31/2021
Coding Updatepegfilgrastim (Neulasta®) and related biosimilars08.01.32f1/1/202212/31/2021
Coding UpdateGenetic Testing (AmeriHealth Administrators)06.02.35ae1/1/202212/31/2021
Coding UpdateAssays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators)06.02.27m1/1/202212/31/2021
Coding UpdateChimeric Antigen Receptor (CAR) Therapy08.01.43j1/1/202212/31/2021
Coding UpdateOrthoptic/Pleoptic Training07.13.01i1/1/202212/31/2021
Coding UpdateAutonomic Nervous System Testing07.03.23e1/1/202212/31/2021
Coding UpdateCataract Surgery11.01.07f1/1/202212/31/2021
Coding UpdateStem-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 Conditions07.07.09h1/1/202212/31/2021
Coding UpdateCatheter Ablation of Cardiac Arrhythmias11.02.06n1/1/202212/31/2021
Coding UpdateEndovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms11.02.10p1/1/202212/31/2021
Coding UpdateExtracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions11.14.13h1/1/202212/31/2021
Coding UpdateTelemedicine Services00.10.41i1/1/202212/31/2021
Coding UpdateVagus Nerve Stimulation (VNS)11.15.16q1/1/202212/31/2021
Coding UpdateAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma11.05.16j1/1/202212/31/2021
Coding UpdateNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease06.02.56e1/1/202212/31/2021
Archived PoliciesMelphalan flufenamide (Pepaxto®)08.01.78b12/1/2021 3:00 PM1/1/202212/1/2021
Archived PoliciesIbalizumab-uiyk (Trogarzo™)08.01.46a12/3/2021 1:00 PM1/3/202212/3/2021
Archived PoliciesTagraxofusp-erzs (Elzonris®)08.01.55c12/3/2021 2:00 PM1/3/202212/3/2021