TitleWeb Medical and claim payment policy activity posted October 25 – November 20, 2014
Professional; Facility; Ancillary
December 1, 2014
Page Content [
Below is a listing of the policy activity that we have posted to our website
from October 25 ? November 20, 2014.
New policy
The following policy has 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 |
| 00.01.60 |
Multiple Procedure Payment Reduction (MPPR) on Certain
Diagnostic Services |
October 1, 2014 |
January 1, 2015 |
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 |
| 00.01.56a |
National Correct Coding Initiative (NCCI) Code Pair Edits |
Coverage and/or Reimbursement Position |
October 1, 2014 |
January 1, 2015 |
| 05.00.01i | Pneumatic Compression Therapy Devices for Lymphedema
and Chronic Venous Insufficiency | Medical Necessity
Criteria | October 20, 2014 | November 19, 2014 |
| 05.00.39k | Ankle-Foot/Knee-Ankle-Foot Orthoses | General
Description, Guidelines, or Informational Update; Medical Coding; Medical
Necessity Criteria | October 20, 2014 | November 19, 2014 |
| 07.00.21f | Allergy Immunotherapy | Coverage and/or
Reimbursement Position; Medical Necessity Criteria | August 27,
2014 | November 25, 2014 |
| 07.02.03h | Implantable Cardiac Loop Monitor | Coverage
and/or Reimbursement Position; General Description, Guidelines, or
Informational Update; Medical Coding | October 3, 2014 | January 1,
2015 |
| 07.02.12g | Cardiac Event Detection Monitoring (External Loop
Monitoring) |
Coverage and/or Reimbursement Position; General Description, Guidelines, or
Informational Update; Medical Coding; Medical Necessity
Criteria | October 8, 2014 |
November 7, 2014 |
| 07.05.02l | Wireless Capsule Endoscopy (WCE) as a Diagnostic
Technique in Disorders of the Small Bowel, Esophagus, and Colon | General
Description, Guidelines, or Informational Update; Medical Coding; Medical
Necessity Criteria | October 20, 2014 | November 19, 2014 |
| 07.07.07c | Electrical Stimulation and Electromagnetic
Stimulation for the Treatment of Wounds | Coverage and/or Reimbursement
Position; General Description, Guidelines, or Informational Update
| October 20, 2014 | November 19, 2014 |
| 08.00.57g | Complex Regional Pain Syndrome (CRPS) Parenteral
Treatments |
Coverage and/or Reimbursement Position; General Description, Guidelines, or
Informational Update; Medical Coding; Medical Necessity
Criteria | October 8, 2014 | November 7, 2014 |
| 08.00.73f | Bortezomib (Velcade®) | General
Description, Guidelines, or Informational Update; Medical Coding; Medical
Necessity Criteria | October 8, 2014 | November 7, 2014 |
| 08.00.78n | Self-Administered Drugs | Medical
Coding | October 31, 2014 | December 1, 2014 |
| 08.00.90d | Paclitaxel Protein-bound Particles for Injectable
Suspension (Albumin-bound)/ (Abraxane® for Injectable
Suspension) | Medical Coding; Medical Necessity Criteria | October
8, 2014 | November 7, 2014 |
| 08.00.93b | C1 Esterase Inhibitors: Cinryze®,
Berinert®, and Ruconest® | Coverage and/or
Reimbursement Position; General Description, Guidelines, or Informational
Update; Medical Coding; Medical Necessity Criteria | October 27,
2014 | November 26, 2014 | | 08.01.04h | Preventive
Immunization | Medical Coding; Medical Necessity Criteria |
October 20, 2014 | November 19, 2014 |
| 08.01.12a | Repository Corticotropin (H.P.
Acthar® Gel Injection) | Coverage and/or Reimbursement
Position; General Description, Guidelines, or Informational Update; Medical
Necessity Criteria | August 27, 2014 | November 25, 2014
|
| 09.00.36h | First-Trimester Prenatal Screening for Fetal
Aneuploidy | Medical Coding | August 13, 2014 | Published
November 11, 2014;
Retroactively effective August 13, 2014 |
| 10.03.01e | Physical Medicine, Rehabilitation, and Habilitation
Services | Coverage and/or Reimbursement Position; General Description,
Guidelines, or Informational Update; Medical Coding | October 20,
2014 | November 19, 2014 |
| 11.00.16e | Radiofrequency Ablation and Cryosurgical Ablation of
Lung Tumors | Coverage and/or Reimbursement Position; Medical Necessity
Criteria | October 3, 2014 | January 1, 2015 |
| 11.15.23c | Epidural, Paravertebral Facet, and Sacroiliac Joint
Injections for Spinal Pain Management | Coverage and/or Reimbursement
Position; Medical Coding; Medical Necessity Criteria | October 3, 2014
| January 1, 2015 |
Archived policy
The following is a policy that AmeriHealth has determined is no longer
necessary to remain active.
| Policy # | Title | Notification date | Archive
effective date |
| 08.00.06g | Inpatient Administration of Intravenous
Dihydroergotamine Mesylate (D.H.E.45®) | October 8, 2014
| January 6, 2015 |
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 the
Reference Tools transaction, then Medical Policy. Be sure to
check back often, as the site is updated frequently.
NaviNet® is a registered trademark of
NaviNet, Inc. ]
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