ND Committee Review
Internal Medical Policy Committee 11-23-2021-
Effective January 1, 2022
- Adopted Medicaid Expansion specific policy
Internal Medical Policy Committee 11-29-2022 -
Effective January 1, 2023
- Updated
diagnosis code list,
and
- Updated
initial criteria,
and
- Added
reauthorization criteria,
and
- Updated
experimental/investigational statement
Internal Medical Policy Committee 11-15-2023 Annual Review-no changes in criteria
Internal Medical Policy Committee 11-19-2024
Effective January 01, 2025
-
Annual review no clinical content change;
and
- Added
Policy Application
Internal Medical Policy Committee 01-14-2025
EffectiveMarch 01, 2025
- Updated
initial and reauthorization criteria based on the DHHS PDL Version 2025.1