ND Committee Review
Internal Medical Policy Committee 11-14-2019 Update to v14, addition of non-covered code, verified diagnosis codes.
Internal Medical Policy Committee 3-16-2020 No changes in policy-Annual Review Updated to version 015
Internal Medical Policy Committee 5-20-2021 Annual Review-no changes in Criteria
Internal Medical Policy Committee 5-24-2022 Annual Review-no changes in criteria
Internal Medical Policy Committee 5-23-2023 Annual Review-no changes in criteria
Internal Medical Policy Committee 7-21-2023 Coding Update-
Effective July 21, 2023
- Removed
diagnosis code I80.89;
and
- Added
diagnosis codes I21.9; I24.0; I24.9; I42.4; I92.9; J92.0; R06.4; R06.81; R60.1; and R60.9
Internal Medical Policy Committee 9-17-2024 Coding update -
Effective November 04, 2024
- Removed
diagnosis codes I50.510;
and
- Added
Policy Application
Internal Medical Policy Committee 11-19-2024 Annual Review-no changes in criteria
Internal Medical Policy Committee 5-13-2025 Coding update -
Effective April 01, 2025
- Added
procedure code 0541U