ND Committee Review
Internal Medical Policy Committee 3-16-2020
Internal Medical Policy Committee 7-22-2020 -Effective July 01, 2020
- Removed
procedure code C9399;
and
- Updated
J-code to J0896
Internal Medical Policy Committee 9-21-2020
- Added
new indication, anemia failing an erythropoiesis stimulation agent;
and
- Added
additional diagnosis codes
Internal Medical Policy Committee 9-21-2021 Annual Review
Internal Medical Policy Committee 1-22-2022
- Updated
other indication statement to read 'Luspatercept-aamt (Reblozyl) not meeting the criteria as indicated in this policy is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.'
Internal Medical Policy Committee 1-26-2023 Annual Review - no clinical content change
Internal Medical Policy Committee 3-23-2023
Effective May 01, 2023
- Added
Compendia sources statement '
Drug
may be considered medically necessary for treatment of any of the current category 1 or 2A NCCN recommendations.'
and
- Updated
experimental/investigational statement
Internal Medical Policy Committee 11-15-2023
Effective January 01, 2024
- Added
criteria for Anemia Without Previous Erythropoiesis Stimulating Agent Use
Internal Medical Policy Committee 9-17-2024
Effective November 01, 2024
- Added
diagnosis codes C94.40; C94.41; C94.42; C94.6; D47.1; D47.4; and D75.81
Internal Medical Policy Committee 11-19-2024
Effective December 08, 2024