Effective January 1, 2014, based on local practice patterns, AmeriHealth will consider the procedures listed below to be outpatient procedures, as they are being performed mainly in the outpatient setting and generally no longer require inpatient hospitalization.

The following is a list of procedures that will be considered outpatient procedures for dates of service on or after January 1, 2014:

• thyroidectomy — partial or total
• parathyroidectomy
• recurrent hernia
• temporomandibular joint (TMJ) arthroplasty and discectomy
• arthroscopy (shoulder, elbow, wrist)
• open reduction internal fixation of uncomplicated wrist or finger fractures

We ask that providers perform these procedures as outpatient; however, if you feel there are medical reasons that would justify an inpatient stay, AmeriHealth will review these upon request and approve the inpatient setting if medically appropriate. If we approve these procedures as inpatient and the patient goes home the same day, we will reimburse these procedures as outpatient. You may direct your review requests to the Precertification Department by calling 1-800-275-2583 for providers in Pennsylvania and Delaware or 1-888-YOUR-AH1 (1-888-968-7241) for providers in New Jersey and saying Authorizations.

Please note that as of January 1, 2014, none of the procedures listed above will require precertification if performed in the outpatient setting.

If you have any questions about this notice or criteria for the above procedures, please contact Pamela Weatherbee, Manager of Care Management Coordination, at 215-241-9449.