ND Committee Review
Internal Medical Policy Committee 3-16-2020
Internal Medical Policy Committee 7-22-2020 - Effective July 01, 2020
Internal Medical Policy Committee 9-21-2020
- Removed
procedure code C9061;
and
- Added
new procedure code J3241
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
Internal Medical Policy Committee 1-26-2023 Annual review, no clinical content change
Internal Medical Policy Committee 3-23-2023
Effective May 01, 2023
- Removed
criteria 'Onset of TED symptoms within 9-12 months prior'
- Updated
experimental/investigational statement
Internal Medical Policy Committee 9-12-2023 -
Effective November 01, 2023
- Updated
criteria per Food and Drug Administration (FDA) labeling
- Removed
'moderate to severe'
- Removed
'Clinical activity score (see table below) of greater than or equal to four (4)'
- Removed
Professional Statements and Societal Positions Guidelines
Internal Medical Policy Committee 9-17-2024
Effective November 01, 2024
- Annual review
no clinical content change
Internal Medical Policy Committee 11-19-2024
Effective December 08, 2024