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On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. To learn more about this from Change Healthcare, please visit the Change Healthcare website or reach out to the contact center at 1-866-262-5342. More from Change Healthcare
On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. To learn more about this from Change Healthcare, please visit the Change Healthcare website or reach out to the contact center at 1-866-262-5342. More from Change Healthcare

PA and Policy Updates

PA and Policy Updates 

PA's and Policy Update Notifications Since September 1, 2024

For notifications delivered prior to September 1 please see Updates page.

The following clinical pharmacy policy will be used in determining medical necessity criteria for Ferric Carboxymaltose (Injectafer):  CP.PHAR.234 Ferric Carboxymaltose (Injectafer). 

Procedure Code

Procedure Code Description

New StandardLine of Business

J1439

NJ FERRIC CARBOXYMALTOS 1MG

Pre-authorization is required for All Providers

Medicaid

Procedure Code

Procedure Code Description

New Standard
Line of Business

19303

MASTECTOMY, SIMPLE, COMPLETE

Pre-authorization is required for All Providers

Medicaid


New Payment Policy: Leveling of Care: Evaluation and Management Overcoding Effective 12-1-24 (All Products)

Payment Policy CC.PP.066: Physician medical records should chronologically report the care a patient received and record pertinent facts, findings, and observations about the patient’s health history. See our Policy Website Page for full details.