​Effective January 1, 2024, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) and AmeriHealth Administrators are making changes to the list of services that require precertification under the medical benefit.

Removals

Effective January 1, 2024, facility-to-facility transfers, including the ambulance transport, will no longer require precertification.

Additions

Effective January 1, 2024, Gynecomastia will be moving from not covered to medically necessary when medical policy criteria are met. In alignment with other potentially cosmetic procedures, Gynecomastia will require prior authorization.

Learn more

The complete list of services that require precertification as of January 1, 2024, can be found on the AmeriHealth and AmeriHealth Administrators websites.

Lists of medical codes for services that require precertification in New Jersey and Pennsylvania are available on our Medical and Claim Payment Policy Portal.​