ND Committee Review
Internal Medical Policy Committee 1-22-2020
- Added
new procedure codes E1300; K1003 and K1004 as non-covered.
Internal Medical Policy Committee 7-22-2020 Annual Review
Internal Medical Policy Committee 11-19-2020 Coding update-
- Removed
diagnosis code N18.3;
and
- Added
diagnosis codes N18.30; N18.31; and N18.32
Internal Medical Policy Committee 3-17-2021 Coding update:
- Added
procedure code K1013
Internal Medical Policy Committee 5-20-2021 Coding update:
- Removed
procedure codes A4520; A4554; T4521; T4522; T4523; T4524; T4525; T4526; T4527; T4528; T4529; T4530; T4531; T4532; T4533; T4534; T4535; T4536; T4537; T4538; T4539; T4540; T4541; T4542; T4543; T4544 these appear on policy O-27.
Internal Medical Policy Committee 9-21-2021 Coding update:
- Added
procedure code A4453;
and
- Added
Manual Enema System and covered procedure code A4459;
and
- Added
non-covered procedure codes E0350 and E0352.
Internal Medical Policy Committee 3-23-2022 Revision with coding update;
- Updated
with clarifying language;
and
- Added
Alert Systems and procedure code A9280 to the list of Non-covered Items.
Internal Medical Policy Committee 5-24-2022 Revision
- Added
RomTech Portable Connect Rehab Adaptive Device and procedure code E1399 to Non-covered Items table
Internal Medical Policy Committee 7-21-2022 Coding update
- Added
procedure code E0673 to table: Kinex ThermoComp Compression
Internal Medical Policy Committee 3-23-2023 Annual Review, no changes in criteria
Internal Medical Policy Committee 5-23-2023 Annual Review, no changes in criteria
Internal Medical Policy Committee 11-15-2023 Coding update:
Effective 10/01/2023
- Added
procedure code K1036;
and
- Added
diagnosis codes H50.621; H50.622; H50.629; H50.631; H50.632; H50.639; H50.641; H50.642; H50.649; H50.651; H50.652; H50.659; H50.661; H50.662; H50.669; H50.671; H50.672; H50.679; H50.681; H50.682; and H50.689.
Internal Medical Policy Committee 1-16-2024 - Coding update -
Effective January 01, 2024
- Removed
procedure codes K1003; K1013;
and
- Added
procedure codes A4457; and E1301.
Internal Medical Policy Committee 3-19-2024 Coding update -
Effective April 01, 2024
- Added
procedure code E0152
- Added
Policy Application