ND Committee Review
Internal Medical Policy Committee 11-14-2019 Revision -
Effective January 01, 2020
-
Updated policy to mirror pharmacy CGM policy
Internal Medical Policy Committee 3-16-2020 Coding update
- Removed
invalid diagnosis codes
Internal Medical Policy Committee 7-22-2020 Revision
- Removed
Eversense CGM experimental/investigational statement,
- Updated
description
- Added
additional diagnosis codes: E11.10, E11.11, E11.8 and E11.9
- Added
'Billed with Z79.4' to covered diagnosis codes section
Internal Medical Policy Committee 7-22-2021 Coding update
- Added
diagnosis code Z96.41
Internal Medical Policy Committee 11-23-2021
- Updated
description, non-invasive CGM and remote CGM language
Internal Medical Policy Committee 3-23-2022 Coding update-
Effective April 01, 2022
- Added
new codes A4238 and E2102 to the policy
Internal Medical Policy Committee 7-21-2022 Coding update -
Effective July 01, 2022
- Added
new codes, G0308 and G0309, to the policy
Internal Medical Policy Committee 11-29-2022 Coding update -
Effective January 01, 2023
- Added
new codes, A4239, E2103, 0740T and 0741T to the policy
- Removed
codes G0308, G0309, K0553, and K0554
Internal Medical Policy Committee 5-23-2023 -
Effective June 26, 2023
- Updated
diagnosis table - type 1 diabetes, diabetes in pregnancy, childbirth and the puerperium and insulin pump diagnosis codes will no longer require billing with Z79.4. Type 2 diabetes and other specific diabetes diagnosis codes will still require billing with Z79.4
Internal Medical Policy Committee 7-26-2023 Coding update -
Effective September 01, 2023
- Removed
'short or rapid-acting' from the policy criteria due to updated guidelines
Internal Medical Policy Committee 7-16-2024
Effective September 01, 2024
- Added
code A4226 to the policy
Internal Medical Policy Committee 1-14-2025
Effective January 01, 2025
- Added
codes G0564 and G0565 to the policy
