ND Committee Review
Internal Medical Policy Committee 7-16-2019
- Added procedure codes 0543T; 0544T; 0545T; 0546T; 0547T; 0548T; 0549T: 0550T; 0551T; 0552T; 0553T; 0554T; 0555T; 0556T; 0557T; 0558T; 0559T; 0560T; 0561T; 0562T; 0085U; 0091U; 0092U; 0093U; 0095U; and
- Removed procedure codes C9746; 0509T; 92273; 92274; S8930
- Removed procedure codes 0006U; 0007U; 0011U; 0051U; 0054U; 0082U; 55874
- Added procedure code C9250
Internal Medical Policy Committee 9-26-2019
- Added procedure codes 0105U; 0106U; 0107U; 0108U; 0110U; 0121U; 0122U; 0123U; 0124U; 0125U; 0126U; 0127U; 0128U; and
- Removed procedure codes 0011M; 0012M; 0013M; 0250T; 0251T; 0252T; 0288T; 0399T; 0040U; 0067U; 0068U; 0070U; 0071U; 0072U; 0073U; 0074U; 0075U; 0076U; 0078U; 0079U; Q4193; Q4194; Q4195; Q4196; and Q4197.
Internal Medical Policy Committee 1-22-2020 new code update
- Added procedure codes 0139U; 0143U; 0144U; 0145U; 0146U; 0147U; 0148U; 0149U; 0569T; 0570T; 0581T; 0582T; 0564T; 0565T; 0566T; 0571T; 0572T; 0573T; 0574T; 0575T; 0576T; 0577T; 0578T; 0579T; 0580T; 0583T; 0563T; 0567T; 0568T; 64454; 64624; 64625; C1734; C1824; C1839; C1982; C2596; C9758; K1001; K1002; L2006; and
- Removed procedure codes 0254T; 0016U; 0017U; 0019U; 0022U; 0023U; 0026U; 0027U; 0029U; 0030U; 0031U; 0032U; 0033U; 0034U; 0036U; 0053U; 0055U; 0056U; 0057U; 0069U; 0085U; and
- Added procedure codes 0421T; 0563T; 0567T; 0568T; 0569T; 0570T; 0571T; 0581T; 0582T; and
- Removed procedure codes 33274; 33275; and
- Added procedure codes 0014M; 0163U; 0165U; 0166U; 0167U; 0168U; 0169U; 0170U; 0171U.
Internal Medical Policy Committee 7-22-2020 Coding update
- Removed procedure code 64624; and
- Added procedure Codes: 0174U; 0176U; 0178U; 0379T; 0596T; 0597T; 0598T; 0599T; 0600T; 0601T; 0602T; 0603T; 0604T; 0605T; 0606T; 0607T; 0608T; 0609T; 0610T; 0611T; 0612T; 0613T; 0615T; 0616T; 0617T; 0618T; 0619T; and
- Removed procedure codes: 0594T; 0124U; 0125U; 0126U; 0127U; 0128U; and
- Added Outpatient HCPCS (C codes) C1748; C9759; C9760; C9762; C9763; C9764; C9765; C9766; C9767.
Internal Medical Policy Committee 9-21-2020 Coding update:
- Added Procedure codes: 0015M; K1006; K1009; K1010; K1011; and K1012
- Added Outpatient HCPCS (C code) C9468; and
- Removed procedure codes 0213T; 0214T; 0215T; 0216T;0217T; 0218T; 0594T; 0002U; 0012U; 0016U; 0017U; 0019U; 0021U; 0022U; 0023U; 0029U; 0030U; 0031U; 0032U; 0034U; 0035U; 0036U; 0038U; 0039U; 0041U; 0042U; 0043U; 0044U; 0058U; 0059U; 0061U; 0062U; 0063U; 0064U; 0065U; 0066U; 0069U; 0077U; 0080U; 0083U; 0091U; 0092U; 0093U; 0095U; 0105U; 0106U; 0107U; 0108U; 0110U; 0121U; 0122U; 0123U; 0139U; 0143U; 0144U; 0145U; 0146U; 0147U; 0148U; 0149U; 0150U; 0163U; 0164U; 0165U; 0166U; 0167U
Internal Medical Policy Committee 11-19-2020 Coding update:
- Removed Procedure codes: 31647; 31648; 31649; 31651; 0424T; 0425T; 0426T; 0427T; 0428T; 0429T; 0430T; 0431T; 0432T; 0433T; 0434T; 0435T; 0436T and C1982
Internal Medical Policy Committee 1-19-2021 Coding update: Effective January 01, 2021
- Added Procedure codes: 0620T, 0621T, 0622T, 0623T, 0624T, 0625T, 0626T, 0627T, 0628T, 0629T, 0630T, 0631T, 0632T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 0639T, 30468, 57465, 92229
- Removed Procedure codes: 0111T, 0126T, 0381T, 0382T, 0383T, 0384T, 0385T, 0386T, 0396T, 0400T, 0401T, 0405T, C1982
- Outpatient HCPCS (Codes)
- Added: C1825, C9771, C9772, C9773, C9774, C9775
Internal Medical Policy Committee 3-17-2021 Coding Update: Effective April 01, 2021
- Added Procedure codes: 0243U, 0247U, K1016, K1017, K1018 and K1019;
- Removed Procedure codes: K1010, K1011 and K1012
Internal Medical Policy Committee 5-20-2021 Revision
- Added statement "if 22899 is billed with description of intracept procedure this would be E/I"; and
- Added procedure code 22899; and
- Added Outpatient HCPCS (C Code) C9752
Internal Medical Policy Committee 7-22-2021 Coding Update:
- Added Procedure Codes: 0640T, 0641T, 0642T, 0643T, 0644T, 0645T, 0646T, 0648T, 0649T, 0652T, 0653T, 0654T, 0655T, 0656T, 0657T, 0658T, 0659T, 0660T, 0661T, 0662T, 0663T, 0248U, 0249U.
Internal Medical Policy Committee 9-21-2021 Coding update
- Added Procedure codes: C9779, C9780 and K1023
- Removed Procedure Code: C9076
Internal Medical Policy Committee 11-23-2021 Coding update-Effective January 01, 2022
- Added procedure codes: 0207T, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0697T, 0698T, 33267, 33268, 33269, 42975, 53451, 53452, 53453, 53454, 68841
- Added HCPCS (C code) C1832
- Removed Procedure codes: 0508T, 0554T, 0555T, 0556T, 0557T, 0558T
Internal Medical Policy Committee 1-20-2022 Coding update - Effective March 7, 2022
- Removed Procedure codes: 32994, 42975, and 0581T
Internal Medical Policy Committee 3-23-2022 Coding update - Effective April 01, 2022
- Added Procedure codes: C9782, C9783 and K1030
- Removed Procedure codes: 0412T, 0443T, 0582T, 0619T, 0655T, 92229,C2596,Q2055 and S8040
Internal Medical Policy Committee 5-24-2022 Coding update - Effective July 04, 2022
- Added several procedure codes-too many to list individually.
- Removed Procedure codes: J9021, 64454, 64625, 0440T, 0441T, 0442T
Internal Medical Policy Committee 7-21-2022 Coding update - Various Effective Dates
- Removed Procedure code 68841 - Effective May 01, 2022
- Added Procedure codes: 0717T, 0718T, 0719T, 0721T, 0722T, 0723T, 0724T, 0725T, 0726T, 0727T, 0728T, 0729T, 0730T, 0731T, 0732T, 0733T, 0734T, 0736T, 0737T, 0324U, 0325U, and 75571 - Effective July 01, 2022
- Removed Procedure code 64454; 64625; 90587; J9021 - Effective July 01, 2022
- Removed Procedure code E1629 - Effective September 05, 2022
Internal Medical Policy Committee 9-28-2022 - Effective October 01, 2022
- Removed Procedure code J1952; 61736; 61737; 77089; 77090; 77091 & 77092
Internal Medical Policy Committee 11-29-2022 - Effective January 01, 2023
- Removed procedure codes 0278T; K1016; K1017; K1018; K1019; and
- Added procedure codes Q0240; Q0243; Q0244; Q0245; Q0247; M0240; M0243; M0244; M0245 and M0247
- Removed procedure codes 0475T; 0476T; 0477T; 0478T; 0487T; 0491T; 0492T; 0493T; 0499T; and
- Added procedure codes 30469; 36836; 36837; 33900; 33901; 33902; 33903; 33904; 69728; 69729; 69730; 95919; 0744T; 0745T; 0746T; 0747T; 0748T; 0765T; 0766T; 0767T; 0768T; 0769T; 0771T; 0772T; 0773T; 0774T; 0776T; 0777T; 0778T; 0779T; 0781T; 0782T; 0783T and C1827.
Internal Medical Policy Committee 1-26-2023 - Effective March 06, 2023
- Removed procedure codes 0408T; 0409T; 0410T; 0411T; 0413T; 0414T; 0417T; 0418T - these code are now in policy S-278 Cardiac Contractility Modulation Therapy; and
- Removed procedure codes 0415T; 0416T and C1824; and
- Removed 0656T and 0657T - these codes are now in policy S-279 Vertebral Body Tethering; and
- Added: 0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0173A, E1905, 90666, 90667, 90668, 91300, 91301, 91305, 91306, 91307, 91308, 91309, 91311, Q0220, Q0221, Q0222, Q0243, Q0244, Q0245, Q00247; and
- Removed: 0470T, 0471T
Internal Medical Policy Committee 5-23-2023 - Effective July 03, 2023
- Removed: procedure codes 0173A, 0707T, K1001
- Added procedure codes 0014M, 64913
Internal Medical Policy Committee 7-26-2023-Effective July 01, 2023
- Removed procedure codes 0207T, 0330T, 0507T, 0563T - these codes are now in policy Z-107 Intense Pulsed Light Therapy for the Treatment of Dry Eye Disease; and
- Removed procedure codes 69716, 69719, 69726, 69727, 69728, 69729, 69730; and
- Added procedure codes 0807T, 0808T.
Internal Medical Policy Committee 11-15-2023 - Coding update
- Added procedure codes A9268, A9269, C9790 and C9788 -Effective October 01, 2023
- Added procedure codes A9291 and A9292 - Effective January 01, 2024
Internal Medical Policy Committee 1-16-2024 Coding update - Effective January 01, 2024
- Removed procedure codes 0499T, 0465T, 0533T, 0534T, 0535T, 0536T, 0641T, 0642T, 0768T, 0769T, C9771, and C9788; and
- Added procedure codes 0784T, 0785T, 0811T, 0812T, 0815T, 0820T, 0821T, 0822T, 0858T, 0865T, 0866T, 31242, 31243, 52284, 67516, 92972, 97037, C1601, C1602, C9793, E2001, E3000; and
- Added section for Medicaid Expansion procedure code 0017M and 0018U.
- Removed procedure codes 0015M, 0174U, 0176U, 0178U and 90759 - Effective January 15, 2024
- Removed procedure codes 0001A; 0002A; 0003A; 0004A; 0011A; 0012A; 0013A;0051A; 0052A; 0052A; 0053A; 0054A; 0064A; 0071A; 0072A; 0073A, 0074A; 0081A; 0082A; 0083A; 0091A; 0092A; 0093A; 0094A; 0014M; 0111A; 0112A; 0113A; 0173A; 0497T; 0498T; 0324U; 0325U; 77091; 77092; 91300; 91301; 91305; 91306; 91307; 91308; 91309; 91311; C9752; E1905;K1006; and K1009.
- Added procedure codes 0524T; 36473; and 36474 - Effective March 04, 2024
Internal Medical Policy Committee 3-19-2024 Revision with Coding update- Effective May 06, 2024
- Removed procedure codes 36836; 67516; 90689; and S2348.
- Effective April 01, 2024 - new codes
- Added procedure codes 0443U; 0445U; A4593; A4594; A9293 G0138; and K1037.
Internal Medical Policy Committee 5-14-2024 Coding update - Effective July 1, 2024
- Updated Policy Application
- Removed Procedure Code 0202T and A9293; E1905 inadvertently fell off grid, was added back on.
Internal Medical Policy Committee 7-16-2024 Coding update - Effective July 1, 2024
- Added July New Codes 0459U, 0869T, 0882T, 0883T, 0881T, 0875T, 0877T, 0878T, 0879T, 0880T, 0870T, 0871T, 0872T, 0873T, 0874T, 0875T, 0884T, 0885T, 0886T, 0894T, 0895T, 0896T, C9901, 0897T, 0899T, 0900T, 0888T, 0898T, & 0893T
- Removed Procedure Code C9700
Internal Medical Policy Committee 9-17-2024 Coding update - Effective October 1, 2024
- Added Procedure codes A4544; C8000; E0683; E0743; E0767; E3200; 0479U; 0482U; 0490U; 0491U; 0492U; 0511U; 0512U; and 0513U.
Coding update - Effective November 04, 2024
- Added procedure code E1905; and
- Removed procedure code L2006
Internal Medical Policy Committee 11-19-2024 - Annual Review-no changes in criteria
Internal Medical Policy Committee 1-14-2025
- Coding update - Effective January 01, 2025
- Removed deleted procedure codes 0553T; 0567T; 0616T; 0617T; and 0618T; and
- Added procedure codes 66683; 82233; 82234; 84393; 84394; 92137; 93896; 93897; 93898; 0524U; 0525U; 0901T; 0902T; 0903T; 0904T; 0905T; 0906T; 0907T; 0908T; 0909T; 0910T; 0911T; 0912T; 0913T; 0914T; 0915T; 0916T; 0917T; 0918T; 0919T; 0920T; 0921T; 0922T; 0923T; 0924T; 0925T; 0926T; 0927T; 0928T; 0929T; 0930T; 0931T; 0932T; 0933T; 0934T; 0935T; 0936T; 0937T; 0938T; 0939T; 0940T; 0941T; 0942T; 0943T; 0944T; 0946T; C1735; C1736; C8002; C8003; and C9807.
- Annual Review - no changes in criteria - Effective March 03, 2025
- Updated Policy Application
Internal Medical Policy Committee 3-11-2025 Coding update - Effective May 05, 2025
- Removed procedure codes 92137; 0568T; 0495U; 22899; and 0691T; and
- Added procedure codes 0332T; 0614T; M0076; and S9025
- *Special Note: With the arrival of April New codes from CMS post March IMPC. Procedure code(s) C8004; 0542U; 0545U; 0546U; 0547U; 0548U; 0550U; & 0551U have been added to March's IMPC with the Effective April 01, 2025.
