Below is a listing of the policy activity that we have posted to our website
from May 26 ? June 24, 2014.
New policies
The following policies have been newly developed to communicate coverage and/or
reimbursement positions, reporting requirements, and other processes and
procedures for doing business with AmeriHealth.
Policy #
Title
Notification date
Effective date
00.10.40
Reimbursement for Certified Registered Nurse Practitioners (CRNP)
N/A
January, 1 2014 (policy published on June 4, 2014)
08.01.17
Elosulfase alfa (Vimizim
TM)
June 18, 2014
July 18, 2014
Updated policies
The following policies have been reviewed and updated to communicate current
coverage and/or reimbursement positions, reporting requirements, and other
processes and procedures for doing business with AmeriHealth.
Policy #
Title
Type of policy change
Notification date
Effective date
00.06.02k
Preventive Care Services
Medical Necessity Criteria; Medical Coding
June 5, 2014
September 3, 2014
02.01.01c
Home Health Care Services
Medical Necessity Criteria; Coverage and/or Reimbursement Position; General
Description, Guidelines, or Informational Update
April 23, 2014 (revised June 19, 2014)
July 22, 2014
05.00.14g
High-Frequency Chest Wall Oscillation Devices
Medical Necessity Criteria
June 18, 2014
July 18, 2014
05.00.26c
Prothrombin Time Monitor for Home Anticoagulation Management
Medical Necessity Criteria; Medical Coding; Guidelines
May 5, 2014
June 4, 2014
05.00.30i
Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway
Pressure (CPAP) Devices and Bi-Level Devices
Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or
Informational Update
May 5, 2014
June 4, 2014
07.03.03f
Medical Evaluation and Management for Attention- Deficit Hyperactivity Disorder
(ADHD)
General Description, Guidelines, or Informational Update; Coverage and/or
Reimbursement Position
N/A
June 18, 2014
07.03.15c
Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of
Protective Sensation (LOPS)
General Description, Guidelines, or Informational Update
N/A
June 18, 2014
07.07.01h
Routine Foot Care For Certain Medical Conditions
Informational Update
N/A
June 18, 2014
07.11.01b
Smell and Taste Dysfunction Testing
Medical Coding
N/A
June 4, 2014
08.00.33j
Trastuzumab (Herceptin
®)
Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical
Coding; General Description, Guidelines, or Informational Update
April 23, 2014
July 22, 2014
08.00.34g
Infliximab (Remicade
®)
Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical
Coding; General Description, Guidelines, or Informational Update
May 22, 2014
June 23, 2014
08.00.50l
Rituximab (Rituxan
®)
Medical Coding
March 5, 2014
June 3, 2014
08.00.58c
Risperidone (Risperdal
® Consta
®) Injection
Medical Coding; General Description, Guidelines, or Informational Update
N/A
June 18, 2014
08.00.62e
Abatacept (Orencia
®) for Injection for Intravenous Use
Coverage Position; Medical Necessity Criteria; General Description
March 5, 2014
June 3, 2014
08.00.85d
Tocilizumab (Actemra
®) for Intravenous Infusion
Medical Necessity Criteria; General Description
March 5, 2014
June 3, 2014
08.00.98b
Eribulin Mesylate (Halaven
TM)
Coverage and/or Reimbursement Position; Medical Coding; General Description,
Guidelines, or Informational Update
N/A
June 18, 2014
11.00.06e
Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults
Coverage and/or Reimbursement Position; Medical Coding; General Description,
Guidelines, or Informational Update
April 23, 2014
July 23, 2014
11.02.10j
Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac
Aneurysms, and Infrarenal Aortic Aneurysms
General Description; Coverage Position; Medical Necessity Criteria; Medical
Coding
March 26, 2014
June 24, 2014
12.01.01x
Experimental/ Investigational Services
Medical Coding; Coverage Position
April 10, 2014
July 9, 2014
Reissued policies
The following policies have been reviewed, and no substantive changes were made.
Policy #
Title
Reissue effective date
08.00.49c
Dofetilide (Tikosyn
®) Use In the Inpatient Setting
May 28, 2014 (published May 28, 2014)
11.02.02e
Treatment of Medical and Surgical Complications
May 28, 2014 (published May 29, 2014)
11.08.17d
Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Nails
June 11, 2014 (published June 12, 2014)
To view policy activity, go to our
Medical Policy Portal and
select Accept and Go to Medical Policy Online. You can also view policy
activity using the NaviNet
® web portal by selecting Reference
Tools from the Plan Transactions menu, then Medical Policy. Be sure to check
back often, as the site is updated frequently.
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NaviNet, Inc.