Diagnosis Codes
Covered Diagnosis Codes for Procedure Code J1729
C54.0 | C54.1 | C54.2 | C54.3 | C54.8 | C54.9 | N20.1 |
N20.2 | N20.9 | N91.0 | N91.1 | N91.2 | N93.8 | N93.8 |
Professional Statements and Societal Positions Guidelines
Internal Medical Policy Committee 9-21-2022 -
Effective October 1, 2020
Internal Medical Policy Committee 9-21-2022 - Annual Review, no clinical content change
Internal Medical Policy Committee 3-23-2022 -
Effective May 1, 2022
- Updated
E/I statement
- Updated
Professional Statements and Societal Positions Section
Internal Medical Policy Committee 3-23-2023 - Annual Review, no clinical content change
Internal Medical Policy Committee 5-23-2023 -
Effective April 7, 2023
- Updated
policy to make Makena (hydroxyprogesterone caproate) always experimental/investigational due to the FDA withdrawal of approval of Makena which occurred on April 6, 2023.
- Removed
J1729 from the criteria
- Added
Note concerning J1729
Internal Medical Policy Committee 1-16-2024 -
Effective March 01, 2024
- Added
note: All products under J1729 became inactive as of November 29, 2023
- Added
diagnosis codes for J1729 for any supply that is being depleted