| News & Announcements | 01/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | | | | | | 12/31/2025 | | | |
| Notifications | Telemedicine Services | 00.10.41q | 12/1/2025 10:00 AM | 1/1/2026 | | | 12/1/2025 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Notifications | Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal Ultrasounds | 00.01.72 | 12/2/2025 2:00 PM | 3/2/2026 | | | 12/2/2025 | This is a New Policy. | | |
| Notifications | Reimbursement for Certain Evaluation and Management (E/M) Services | 00.01.69c | 12/2/2025 2:00 PM | 3/2/2026 | | | 12/2/2025 | Coverage and/or Reimbursement Position;Medical Coding | | |
| Notifications | Reimbursement of Surgical Pathology Services for Prostate Biopsy | 00.01.73 | 12/2/2025 2:00 PM | 3/2/2026 | | | 12/2/2025 | This is a New Policy. | | |
| Notifications | Bariatric Surgery | 11.03.02x | 12/16/2025 12:00 PM | 3/17/2026 | | | 12/16/2025 | Coverage and/or Reimbursement Position;Medical Coding | | |
| Notifications | Preventive Care Services | 00.06.02ax | 10/3/2025 11:00 AM | 1/1/2026 | | | 12/17/2025 | Medical Necessity Criteria;Medical Coding | | 12/17/2025 |
| Notifications | Intravenous (IV) Iron Preparations | 08.02.29a | 12/23/2025 9:00 AM | 3/23/2026 | | | 12/23/2025 | Medical Necessity Criteria | | |
| Notifications | Fertility Preservation (AmeriHealth New Jersey) | 07.10.08g | 12/23/2025 3:00 PM | 1/26/2026 | | | 12/23/2025 | Medical Necessity Criteria | | |
| Notifications | Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty | 11.16.01m | 12/26/2025 9:00 AM | 3/30/2026 | | | 12/26/2025 | Coverage and/or Reimbursement Position;Medical Coding | | |
| Notifications | Preventive Care Services | 00.06.02ax | 10/3/2025 11:00 AM | 1/1/2026 | | | 12/29/2025 | Medical Necessity Criteria;Medical Coding | | |
| New Policies | Penpulimab-kcqx | 08.02.42 | | 12/29/2025 | | | 12/29/2025 | This is a New Policy. | | |
| New Policies | Revakinagene taroretcel-lwey (Encelto®) | 08.02.44 | | 12/29/2025 | | | 12/29/2025 | This is a New Policy. | | |
| New Policies | Laser Interstitial Thermal Therapy (LITT) | 07.03.28 | | 1/1/2026 | | | 12/31/2025 | This is a New Policy. | | |
| New Policies | Renal Denervation for Uncontrolled Hypertension | 11.02.29 | | 1/1/2026 | | | 12/31/2025 | This is a New Policy. | | |
| Updated Policies | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services [AmeriHealth New Jersey] | 00.01.60j | 8/29/2025 10:00 AM | 12/1/2025 | | | 12/1/2025 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis | 11.14.07y | | 12/1/2025 | | | 12/1/2025 | Medical Necessity Criteria | | |
| Updated Policies | Private Duty Nursing | 02.01.02e | | 12/1/2025 | | | 12/1/2025 | Medical Necessity Criteria | | |
| Updated Policies | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 00.01.68c | 8/29/2025 10:00 AM | 12/1/2025 | | | 12/1/2025 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Reporting and Documentation Requirements for Anesthesia Services | 00.01.14t | 8/29/2025 10:00 AM | 12/1/2025 | | | 12/1/2025 | Coverage and/or Reimbursement Position;Medical Necessity Criteria | | |
| Updated Policies | Medical Necessity | 12.01.02c | | 12/15/2025 | | | 12/15/2025 | Medical Necessity Criteria | | |
| Updated Policies | Avelumab (Bavencio®) | 08.01.64e | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®) | 08.01.33l | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies | 05.00.74l | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria | | |
| Updated Policies | Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorder (ASD) | 14.00.03b | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria | | |
| Updated Policies | Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®) | 08.01.80d | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria | | |
| Updated Policies | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 11.08.06l | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria | | |
| Updated Policies | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | 06.02.01l | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Pertuzumab (Perjeta®) | 08.01.07k | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Lumasiran (Oxlumo®) | 08.01.74c | | 12/29/2025 | | | 12/29/2025 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Ipilimumab (Yervoy®) | 08.01.01o | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Therapeutic Transcranial Magnetic Stimulation (TMS) | 07.03.22g | | 12/29/2025 | | | 12/29/2025 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Prescription Digital Therapeutics and Mobile-Based Health Management Applications | 12.00.05e | | 12/29/2025 | | | 12/29/2025 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Polatuzumab vedotin-piiq (Polivy®) | 08.01.59f | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | 00.09.01l | | 12/29/2025 | | | 12/29/2025 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Mirikizumab-mrkz (Omvoh®) for Intravenous Use | 08.02.19a | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria | | |
| Updated Policies | Cemiplimab-rwlc (Libtayo®) | 08.01.66e | | 12/29/2025 | | | 12/29/2025 | Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease | 08.01.93f | | 1/1/2026 | | | 12/31/2025 | Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update | | |
| Updated Policies | Self-Administered Drugs and Biologics | 08.00.78aw | | 1/1/2026 | | | 12/31/2025 | Coverage and/or Reimbursement Position;Medical Coding | | |
| Updated Policies | Bundled Procedure Codes | 00.01.52y | 10/1/2025 2:00 PM | 12/31/2025 | | | 12/31/2025 | Coverage and/or Reimbursement Position | | |
| Updated Policies | Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®) | 08.00.94u | | 1/1/2026 | | | 12/31/2025 | Medical Necessity Criteria | | |
| Updated Policies | Reimbursement for Outpatient Emergency Department Visits [AmeriHealth New Jersey] | 00.10.03m | 10/1/2025 10:00 AM | 1/1/2026 | | | 12/31/2025 | Coverage and/or Reimbursement Position | | |
| Reissue Policies | Gender-Affirming Interventions | 11.09.02r | | 7/1/2025 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Chemical Peels | 11.08.08h | | 12/26/2022 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Deep Brain Stimulation (DBS) | 11.15.20t | | 1/2/2024 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Refractive Keratoplasty | 11.05.01g | | 7/1/2022 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Luspatercept–aamt (Reblozyl®) | 08.00.10d | | 1/17/2025 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Day Rehabilitation | 10.00.02c | | 1/13/2020 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects | 07.13.11k | | 10/1/2021 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Vagus Nerve Stimulation (VNS) | 11.15.16w | | 1/6/2025 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Omalizumab (Xolair®) | 08.00.55m | | 1/6/2025 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Cataract Surgery | 11.01.07g | | 6/17/2024 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Inclisiran (Leqvio®) | 08.01.91a | | 1/2/2024 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Evinacumab-dgnb (Evkeeza®) | 08.01.76d | | 5/27/2024 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Sutimlimab-jome (Enjaymo) | 08.01.87a | | 10/1/2022 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Apos® biomechanical shoe system | 05.00.84 | | 1/1/2024 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Cervical Traction Devices for In-home Use | 05.00.61h | | 1/6/2025 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Cerliponase alfa (Brineura®) | 08.01.39d | | 12/2/2024 | 12/10/2025 | | 12/10/2025 | | | |
| Reissue Policies | Cranial Electrotherapy Stimulation | 05.00.80d | | 1/1/2024 | 12/19/2025 | | 12/19/2025 | | | |
| Reissue Policies | Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds | 11.08.20aq | | 10/1/2025 | 12/19/2025 | | 12/19/2025 | | | |
| Reissue Policies | Treatment of Medical and Surgical Complications | 11.00.02i | | 10/1/2024 | 12/19/2025 | | 12/19/2025 | | | |
| Reissue Policies | Beremagene Geperpavec (Vyjuvek™) | 08.02.10b | | 7/15/2024 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Eladocagene exuparvovec-tneq (Kebilidi™) | 08.02.37 | | 11/13/2024 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Elivaldogene Autotemcel [eli-cel (Skysona®)] | 08.01.92 | | 5/22/2023 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Insertion of Implantable Infusion Pumps | 11.15.03o | | 10/1/2024 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (AmeriHealth Administrators) | 06.02.47f | | 1/1/2025 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Immune Cell Function Assay | 06.02.37a | | 11/6/2015 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (AmeriHealth Administrators) | 06.02.09g | | 7/1/2016 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Lovotibeglogene autotemcel (Lyfgenia®) | 08.02.15 | | 1/1/2025 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Rapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic Disorders | 06.02.46a | | 1/1/2024 | 12/19/2025 | | 12/22/2025 | | | |
| Reissue Policies | Casgevy™ (exagamglogene autotemcel) | 08.02.14a | | 7/1/2025 | 12/19/2025 | | 12/22/2025 | | | |
| Coding Update | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | 06.02.54d | | 10/1/2025 | | | 12/22/2025 | | | |
| Coding Update | eviCore Lab Management (AmeriHealth) | 06.02.52al | | 10/1/2025 | | | 12/24/2025 | | | |
| Archived Policies | Topical Oxygenation | 07.00.09d | 12/1/2025 12:00 PM | 1/1/2026 | | | 12/1/2025 | | | |
| Archived Policies | Photocoagulation of Macular Drusen | 11.05.08d | 12/12/2025 12:00 PM | 1/12/2026 | | | 12/12/2025 | | | |
