ND Committee Review
Internal Medical Policy Committee 4-6-2020 Revision
- Added
COVID-19 Diagnosis Codes for coverage
Internal Medical Policy Committee 9-21-2020: Coding update -
- Removed
Diagnosis Code J84.17;
and
- Added
Diagnosis Codes J84.170 and J84.178
Internal Medical Policy Committee 1-19-2021 Coding update
- Added
Diagnosis Code J12.82
Internal Medical Policy Committee 5-20-2021 Annual Review- updated language
Internal Medical Policy Committee 5-24-2022 Coding update -
- Added
Diagnosis Code Q20.2
Internal Medical Policy Committee 5-23-2023 -Annual Review - no changes in criteria
Internal Medical Policy Committee 5-14-2024 -Annual Review - no changes in criteria
Internal Medical Policy Committee 5-13-2025- Coding update
effective
July 07, 2025
- Added
coverage statement under criteria;
and
- Added
Diagnosis Codes P28.30; P28.32; P28.33; and P28.39;
and
- Removed
diagnosis code P28.3.