ND Committee Review
Internal Medical Policy Committee 7-16-2019 Adopted policy
Internal Medical Policy Committee 7-22-2020 Coding update
- Added
one additional diagnosis code to policy, Z85.068
Internal Medical Policy Committee 7-22-2021 Annual review, no clinical content change
Internal Medical Policy Committee 9-21-2021 Added additional NCCN recommendation
Internal Medical Policy Committee 9-28-2022 Annual Review-no changes in criteria
Internal Medical Policy Committee 11-29-2022
- Removed
NCCN recommendations;
and
- Added
this statement 'Ziv-aflibercept (Zaltrap) may be considered medically necessary for treatment of any of the current category 1 or 2A NCCN recommendations.';
and
- Updated
experimental/investigational statement;
and
- Removed
diagnosis codes C17.0, C17.1, C17.2, C17.8, C17.9, Z85.038 and Z85.068
Internal Medical Policy Committee 11-15-2023 Annual review, no clinical content change
Internal Medical Policy Committee 11-19-2024
Effective December 08, 2024