ND Committee Review
Internal Medical Policy Committee 3-16-2020 Adopted new policy
Internal Medical Policy Committee 7-22-2020 Added new code, C9061, effective 7-1-2020
Internal Medical Policy Committee 9-21-2020 Added new code, J3241, removed C9061
Internal Medical Policy Committee 1-19-2020 Annual review, no clinical content change
Internal Medical Policy Committee 1-19-2021 Annual review, no clinical content change
Internal Medical Policy Committee 1-20-2022 Updated criteria wording and added diagnosis code E05.01