ND Committee Review
Internal Medical Policy Committee 11-14-2019 (Update No Change to Criteria)
Internal Medical Policy Committee 1-22-2020 Coding update
Internal Medical Policy Committee 3-17-2021 Revised policy language
Internal Medical Policy Committee 1-20-2022 Revised policy
Internal Medical Policy Committee 1-26-2023 Revision
- Removed
experimental/investigational statements.
Internal Medical Policy Committee 11-15-2023 Revision and Coding updates -
Effective January 01, 2024
- Added
verbiage for Lantidra
- Added
procedure codes J3490, J3590, and C9399
- Added
diagnosis codes E10.10, E10.1, E10.21, E10.22, E10.29, E10.35, E10.36, E10.40, E10.41, E10.42, E10.44, E10.61, E10.62, E10.63, E10.64, E10.65, E10.69, and E10.9
- Updated
references.
Internal Medical Policy Committee 11-19-2024
Effective December 08, 2024