Effective January 18, 2021, AmeriHealth will require providers to submit administration procedure codes with appropriate drug, substance, and/or biologic agent codes. Our policy indicates that AmeriHealth will only cover the administration of drugs, substances, and/or biologic agents for an individual if the outlined criteria is met. Claims submitted without an appropriate drug, substance, and/or biologic agent code may not be covered.
For more information and the billing requirements, please refer Claim Payment Policy #00.10.43: Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents, which was posted as a Notification on October 19, 2020, and will go into effect January 18, 2021.
To view the Notification for this policy, visit our Medical and Claim Payment Policy Portal and select Active Notifications.