ND Committee Review
Internal Medical Policy Committee 11-19-2020 Adopt policy, was previously policy number I-9008
Internal Medical Policy Committee 1-19-2021 Added new code C9071 effective 1-1-2021
Internal Medical Policy Committee 3-17-2021 Added new code J1427 and removed code C9071 from policy effective 4-1-2021
Internal Medical Policy Committee 3-23-2022 Annual Review - no changes in criteria
Internal Medical Policy Committee 3-23-2023 Annual review, no clinical content change