ND Committee Review
Original Effective Date: April 1, 2020
Internal Medical Policy Committee 3-16-2020 New policy for ND
Internal Medical Policy Committee 7-22-2020 Add new code, J9177, effective 7-1-2020
Internal Medical Policy Committee 3-17-2021 Annual review, no clinical content change
Internal Medical Policy Committee 3-23-2022 Annual review-no changes in criteria
Internal Medical Policy Committee 5-24-2022 Removed NCCN recommendations and added this statement "Enfortumab vedotin (Padcev) may be considered medically necessary for treatment of any of the current category 1 or 2A NCCN recommendations.", removed diagnosis codes (Z85.51 and Z85.59), updated the experimental/investigational statement