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​​​Change to policy on laboratory services for members enrolled in HMO or HMO-POS products​

April 24, 2023

Effective July 31, 2023, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey will update their claim payment policy on laboratory services for mem​bers enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) products for Commercial members.

Policy number 00.03.07ak will be updated to communicate the removal of provider specialty exceptions in the office setting for certain laboratory services identified in attachment B1 of this policy, due to no or low utilization, as follows:

​Specialty
​Procedure Code
​Allergy and Immunology Specialty
​89190
​Cardiology and Interventional Cardiology Specialty
​83880
​Hematology Oncology and Medical Oncology Specialty
​85007, 85008, 85009, 85013, 85014, 85027, 85032, 85044, 85048
​Nephrology Specialty
​81015, 81007
​Orthopedic Surgery Specialty
​89050, 89051, 89060
​Reproductive Endocrinology Specialty
​G0027
​Rheumatology and Pediatric Rheumatology Specialty
​83872, 85810, 89050, 89051, 89055
​Urology Specialty
​G0027, 81015, 81020, 87205, 81007
​

For more information, please view #00​.03.07ak: Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products​, which was published as a notification on April 21, 2023.


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