ND Committee Review
Internal Medical Policy Committee 11-14-2019 Annual Review
Internal Medical Policy Committee 1-22-2020 Coding update
Internal Medical Policy Committee 1-19-2021 Annual Review
Internal Medical Policy Committee 1-20-2022 Annual Review-no changes in criteria
Internal Medical Policy Committee 1-26-2023 Annual Review-no changes in criteria
Internal Medical Policy Committee 3-19-2024 Revision -
Effective May 6, 2024
- Changed
criteria verbiage;
and
- Removed
diagnosis codes M26.609; M26.619; M26.629; M26.639;
and
- Removed
procedure codes 95127 and 95851;
and
- Added
diagnosis codes M26.641; M26.642; M26.643; M26.651; M26.652; M26.653;
and
- Added
procedure codes 20605; 20606; 21010; 21085; 21089; 21110; 97027; 97110; 97112; 97129; 97130; 97530; D9944; D9945; and D9946;
and
- Added
Policy Application
Internal Medical Policy Committee 5-14-2024 Revision -
Effective April 18, 2024
- Removed
procedure codes 97024, 97110, 97112, 97124, 97140, 97530, 97799, E0720 & E0730 from Covered Diagnosis codes section.
- Updated
Policy Application
Internal Medical Policy Committee 5-14-2024 Revision -
Effective July 1, 2024
- Removed
procedure codes 20605, 50606, and 64400 from Covered Diagnosis Codes section.