ND Committee Review
Internal Medical Policy Committee 1-22-2020
- Removed
Deep Brain Stimulation and made it, it's own policy
Internal Medical Policy Committee 11-19-2020 Revision of policy
- Expanded
indications; definitions of indications; and E/I statements;
and
- Removed
Procedure Codes;
and
- Added
Procedure Codes;
and
- Added
Diagnosis codes: G47.31; G47.34; G47.35; G47.36; and G47.37 for Phrenic Nerve Stimulation (64575, 64580, 64585, 64590,64595, L8680, L8682, L8683, L8685, L8686, L8687, L8688, L8689, L8696, 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T)
Internal Medical Policy Committee 1-19-2021 Coding update:
- Removed
procedure codes 64561 and 64581;
and
- Added
procedure codes 64999
Internal Medical Policy Committee 3-17-2021 Coding update -
Effective April 01, 2021
- Added
Procedure code K1020
Internal Medical Policy Committee 9-21-2021 Coding update
Effective October 01, 2021
:
- Added
Procedure codes: 64555; 64999; 95976; E1399;
and
- Added
Diagnosis codes: G43.001; G43.009; G43.011; G43.019; G43.101; G43.109; G43.111; G43.119; G44.021; G44.029; G44.001; and G44.009;
and
- Revised
language for clarity
Internal Medical Policy Committee 11-23-2021
- Added
statement regarding PENFS device
Internal Medical Policy Committee 7-21-2022 Revision with Coding -
Effective July 01, 2022
- Added
Procedure code 0720T
-
Revision that is
Effective September 05, 2022
- Revision of criteria throughout policy
- Added
Procedure codes 0278T; 95977; K1016; K1017; L8679; and L8695
- Added
Diagnosis code Z45.42
- Added
s
ubtitle '
Implantable Peripheral Nerve Stimulator'
to that section of policy.
Internal Medical Policy Committee11-29-2022 Coding update -Effective January 01, 2023
- AddedProcedure code C1826
Internal Medical Policy Committee 3-23-2023 Coding update -
Effective April 01, 2023
- Added
Procedure code L8678
Internal
Medical Policy Committee 1-16-2024 Coding update -
Effective January 01, 2024
- Removed
procedure codes 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, K1016, K1017, K1018, K1019, K1020;
and
- Added
procedure codes 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 64596, 64597, 64598, 93150, 93151, 93152, 93153, A4541,A4542, E0733, E0734, E0735.
- Removed
section
Remote Electrical Neuromodulation as it is now found in policy E-88 Nerivio -
Effective March 04, 2024.
Internal Medical Policy Committee 3-19-2024 Revision with coding update -
Effective May 06, 2024
- Updated
criteria;
and
- Removed
sections Percutaneous Electrical Nerve Field Stimulator;
and
- Removed
section Percutaneous Electrical Nerve Field Stimulator - see policy Z-108;
and
- Removed
procedure code 0720T;
and
- Added
Percutaneous Electrical Nerve Field Stimulator;
and
- Added
non-covered diagnosis codes section for Restorative Neurostimulation Therapy;
and
- Added
diagnosis codes M62.5A2; M56.83; M53.87; M54.41; M54.42; M54.51; M54.59; M54.89;
and
- Added
Policy Application.