ND Committee Review
Internal Medical Policy Committee 1-22-2020 Adding new codes as non-covered.
Internal Medical Policy Committee 7-22-2020 Annual Review
Internal Medical Policy Committee 11-19-2020 Coding update- Removed N18.3; Added N18.30; N18.31; and N18.32
Internal Medical Policy Committee 3-17-2021 Coding update: Added E0350, E0352, K1013
Internal Medical Policy Committee 5-20-2021 Coding update: Removed 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; Covered procedure code A4459 and 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 11-15-2023 Coding update: Effective 10/01/2023
- Added procedure code K1036.
- 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, H50.689.
