ND Committee Review
Internal Medical Policy Committee 1-2024
Effective January 01, 2024
Internal Medical Policy Committee 3-19-2024
Effective April 01, 2024
- Added
new code, C9168, to the policy
Internal Medical Policy Committee 5-14-2024
Effective July 01, 2024
- Added
new code, J2267, to the policy
- Removed
code, C9168, from the policy
Internal Medical Policy Committee 11-19-2024
Effective December 01, 2024
- Updated
criteria based on the DHHS PDL Version 2024.6
Internal Medical Policy Committee 03-11-2025
Effective April 01, 2025
- Updated
criteria by adding Crohn's Disease indication and failed agents based on the DHHS PDL Version 2025.3