ND Committee Review
Internal Medical Policy Committee 9-26-2019 updated coding
Internal Medical Policy Committee 5-19-2020 Annual review
Internal Medical Policy Committee 01-19-2021 Coding Update;
- Removed
procedure code 95071
Internal Medical Policy Committee 01-20-2022 Coding update:
- Removed
Leukocyte histamine release
and
- Removed
procedure code 86343
Internal Medical Policy Committee 11-29-2022 Coding update -
Effective January 02, 2023
- Added
diagnosis codes K90.49; Z91.018
Internal Medical Policy Committee- 3-23-2023 Coding update -
Effective May 01, 2023
- Removed
diagnosis code R05;
and
- Added
diagnosis code R05.3
Internal Medical Policy Committee 1-14-2025 Revision with Coding update -
Effective March 03, 2025
- Removed
Diagnosis Codes: J33.0; J33.8; J34.3; and K20.0
and
- Added
Covered Diagnosis Codes for Procedure Codes 95004; 95017; 95018; 95024; 95027; 95028: T42.0X5A; T42.0X5D; T42.0X5S; T42.1X5A; T42.1X5S; Z91.014; Z91.040; & Z91.041;
and
- Added
Covered Diagnosis Codes for Procedure Code 95044: L24.A1; L24.A2; L50.1; & L50.6;
and
- Added
Covered Diagnosis Codes for Procedure Code 95052: L56.4; L56.5; & L56.9;
and
- Added
Covered Diagnosis Codes for Procedure Codes 95076, and 95079: L27.0; L27.2; L27.8; L27.9; T36.1X5A; T36.1X5D; T36.1X5S; T36.2X5A; T36.2X5D; T36.2X5S; T36.3X5A; T36.4X5A; T36.4X5D; T36.4X5S; T36.5X5A; T36.5X5D; T36.5X5S; T36.6X5A; T36.7X5A; T36.7X5D; T36.7X5S; T36.8X5A; T36.8X5D; T36.8X5S; T37.0X5A; T37.0X5D; T37.0X5S; T37.1X5A; T37.1X5D; T37.1X5S; T37.4X5A; T37.4X5D; T37.4X5S; T37.5X5A; T37.5X5D; T37.5X5S; T38.0X5A; T38.0X5D; T38.0X5S; T38.1X5A; T38.1X5D; T38.1X5S; T38.2X5A; T38.2X5D; T38.2X5S; T38.3X5A; T38.3X5D; T38.3X5S; T38.4X5A; T38.4X5D; T38.4X5S; T38.5X5A; T38.5X5D; T38.5X5S; T38.6X5A; T38.6X5D; T38.6X5S; T38.7X5A; T38.7X5D; T38.7X5S; T38.815A; T38.815D; T38.815S; T38.895A; T38.895D; T38.895S; T38.995A; T38.995D; T38.995S; T39.015A; T39.015D; T39.015S; T39.095A; T39.095D; T39.095S; T39.1X5A; T39.1X5D; T39.1X5S; T39.1X5A; T39.1X5D; T39.1X5S; T39.2X5A; T39.2X5D; T39.2X5S; T39.315A; T39.315D; T39.315S; T39.4X5A; T39.4X5D; T39.4X5S; T40.0X5A; T40.0X5D; T40.0X5S; T40.3X5A; T40.3X5D; T40.3X5S; T40.415A; T40.415D; T40.415S; T40.425A; T40.425D; T40.425S; T40.495A; T40.495D; T40.495S; T40.5X5A; T40.5X5D; T40.5X5S; T40.715A; T40.715D; T40.715S; T40.725A; T40.725D; T40.725S; T42.2X5A; T42.2X5D; T42.2X5S; T42.3X5A; T42.3X5D; T42.3X5S; T42.4X5A; T42.4X5D; T42.4X5S; T42.5X5A; T42.5X5D; T42.5X5S; T43.015A; T43.015D; T43.015S; T43.025A; T43.025D; T43.025S; T43.1X5A; T43.1X5D; T43.1X5S; T43.3X5A; T43.3X5D; T43.3X5S; T43.4X5A; T43.4X5D; T43.4X5S; T43.615A; T43.615D; T43.615S; T43.625A; T43.625D; T43.625S; T43.655A; T43.655D; T43.655S; T50.Z15A; T50.Z15D; T50.Z15S; T63.024A, T63.024D; T63.024S; T78.04XA; T78.04XD; T78.04XS; T50.Z15S; Z91.014; Z91.030; Z91.040; and Z91.048;
and
- Changed
medically necessary to experimental/investigational for Skin Endpoint Titration (SET) section.
