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
- Added diagnosis codes I21.9, I24.0, I24.9, I42.4, I92.9, J92.0, R06.4, R06.81, R60.1, and R60.9