ND Committee Review
Internal Medical Policy Committee 11-14-2019 Updated codes
Internal Medical Policy Committee 3-16-2020 Changed to a pre-certification policy
Internal Medical Policy Committee 11-19-2020 Annual review, no clinical content change
Internal Medical Policy Committee 11-23-2021 Annual review, no clinical content change
Internal Medical Policy Committee 5-24-2022
- Removed NCCN recommendations and
- Added this statement "Elotuzumab (Empliciti)) may be considered medically necessary for treatment of any of the current category 1 or 2A NCCN recommendations.",
- Removed dx Z85.79
Internal Medical Policy Committee 5-23-2023 Annual review, no clinical content change