ND Committee Review
Internal Medical Policy Committee
11-14-2019
All four (4) of these policies
:
- Thermal Capsulorrhaphy for Joint Instability
(BCBSA archived March 2016;
and
-
ND kept;
Saliva Hormone Testing
(ND had own policy as non-covered);
and
- Dynamic Posturography
(ND had BCBSA policy as non-covered);
and
- Diagnosis and Management of Idiopathic Environmental Intolerance - Clinical Ecology
(ND using BCBSA policy) are included.
Internal Medical Policy Committee
11-19-2020
- Removed:
2 exclusions from E/I section;
and
- Removed:
Procedure codes 31627 & 43499.
Internal Medical Policy Committee
5-20-2021
- Added:
Procedure code S2107 as E/I.
Internal Medical Policy Committee
11-23-2021
Revision
- Updated
clarifying language
Internal Medical Policy Committee
5-24-2022
Revision with coding update
- Added:
Procedure code 93998
Internal Medical Policy Committee 3-23-2023 Annual Review-no changes in criteria
Internal Medical Policy Committee 1-16-2024 Revision -
Effective March 04, 2024
- Removed
procedure code 81506;
and
- Removed
Outpatient HCPCS (C Codes) and procedure code C9751;
and
- Updated
references
- Added
Policy Application