ND Committee Review
Internal Medical Policy Committee 5-19-2020 Removed PSA and codes due to ND Mandate
Internal Medical Policy Committee 9-21-2020 ND adding indication for CA-125 for individuals with BRCA mutation to screen for ovarian cancer
Internal Medical Policy Committee 5-20-2021 Coding update-Removed Z80.41, Added C56.1; C56.2; C56.9
Internal Medical Policy Committee 7-22-2021 Coding update-Added C45.1, C48.0, C48.1, C48.2, C48.8, C51.8, C53.0, C54.1, C54.2, C54.3, C54.9, C56.1, C56.2, C56.9, C57.00, C57.01, C57.02, C57.4, C57.7, C57.8, and C78.6 covered under procedure code 86304; Removed procedure code 86849 throughout policy
Internal Medical Policy Committee 9-21-2021 Updating wording and Added diagnosis codes C56.3; C76.0; C79.63 and Z12.71
Internal Medical Policy Committee 5-24-2022 Revision with Coding updates
- Covered Diagnosis Codes for Procedure Code 86304
- Removed Diagnosis codes: C56.9; C57.00; C79.60 and D39.10
- Added Diagnosis codes: C45.0; C45.2; C45.7 and C45.9
- Covered Diagnosis Codes for Procedure Code 86300
- Removed Diagnosis codes: C50.019; C50.029; C50.119; C50.129; C50.219; C50.229; C50.319; C50.329; C50.419; C50.429; C50.519; C50.529; C50.619; C50.629; C50.819;C50.829; C50.919; C50.929; D05.10; D05.80 and D05.90
- Covered Diagnosis Codes for Procedure Codes 82105 and 84702
- Removed:00; C62.10; C62.90; and Z80.0
- Added: 440; Q87.3 and Q87.89