Medical Policy

Terms and Conditions

The Medical Policy Portal offers streamlined navigation to the various types of policies available. Once you accept the terms and conditions below, you’ll be connected to the Medical Policy Portal. From there, simply click the applicable policy portfolio (i.e., Commercial, Medicare Advantage) from the selections across the top of the page to access the specific policies.

By clicking “Accept” below, I acknowledge receipt of the following information:

  • The Policy Bulletins on this website were developed to allow AmeriHealth to administer the provisions of members’ benefits plans and neither constitutes nor substitutes for medical advice. AmeriHealth’s Policy Bulletins should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures. If members have a specific question about their medical condition, they should consult with their provider.
  • Providers are responsible for providing medical advice and treatment, are independent contractors, and are not employees or agents of AmeriHealth.
  • Policy Bulletins are written with medical terminology and in a style common to scientific literature and convention.
  • The Policy Bulletins are used in making decisions as to medical necessity only and do not describe or consider individual benefits. As a result, they do not guarantee coverage of services or guarantee payment. If you are an AmeriHealth member, please refer to your specific benefit plan documents for the terms, conditions, limitations, and exclusions of your coverage. Benefits may vary based on the type of program (HMO, PPO, or other) as well as the benefit design selected by an employer or group (i.e., health and welfare fund, school district).
  • AmeriHealth makes decisions on coverage considering the Policy Bulletins, benefit plan documents, and the member’s medical history and condition.
  • Policy Bulletins are compliant with all applicable laws and regulations, standards of regulatory and accreditation agencies (e.g., NCQA), and, when applicable, the Centers for Medicare and Medicaid Services (CMS).
  • The Policy Bulletins describe the status of medical technology at the time the Bulletins were developed. Since that time, new technology may have emerged or new medical literature may have been published. Policy Bulletins will be reviewed regularly and be updated as scientific and medical literature becomes available.
  • These materials contain Current Procedural Terminology (CPT®). All rights reserved. CPT is a registered trademark of the American Medical Association.
  • These materials contain Current Dental Terminology (CDT©). All rights reserved. CDT is a trademark of the American Dental Association.

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