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1/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products
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Inclusion of a code in this document does not imply reimbursement. Medical necessity, eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.
ELIGIBLE
| 22836 |
| 22837 |
| 22838 |
| 58580 |
| 61889 |
| 61891 |
| 61892 |
| 67516 |
| 75580 |
| 76984 |
| 76987 |
| 76988 |
| 76989 |
| 81457 |
| 81458 |
| 81459 |
| 82166 |
| 86041 |
| 86042 |
| 86043 |
| 86366 |
| 87523 |
| 90589 |
| 90623 |
| 92622 |
| 92623 |
| 93584 |
| 93585 |
| 93586 |
| 93587 |
| 93588 |
| 96547 |
| 96548 |
| 0425U |
| 0426U |
| 0429U |
| 0784T |
| 0785T |
| 0786T |
| 0787T |
| 0788T |
| 0789T |
| 0790T |
0824T
|
| A6567 |
| A6568 |
| A6569 |
| A6570 |
| A6571 |
| A6572 |
| A6573 |
| A6574 |
| A6575 |
| A6576 |
| A6577 |
| A6578 |
| A6579 |
| A6580 |
| A6581 |
| A6582 |
| A6583 |
| A6584 |
| A6585 |
| A6586 |
| A6587 |
| A6588 |
| A6589 |
| A6593 |
| A6594 |
| A6595 |
| A6596 |
| A6597 |
| A6598 |
| A6599 |
| A6600 |
| A6601 |
| A6602 |
| A6603 |
| A6604 |
| A6605 |
| A6606 |
| A6607 |
| A6608 |
| A6609 |
| A6610 |
A9608
|
| C7556 |
| C7557 |
| C7558 |
| C7560 |
| C7903 |
| C9159 |
| C9160 |
| C9161 |
| C9162 |
| C9163 |
| C9164 |
| C9165 |
| C9793 |
| C9794 |
| C9795 |
| E2001 |
| G0011* |
| G0012* |
| G0013* |
| G0017 |
| G0018 |
| G0137 |
| J0184 |
| J0217 |
| J0391 |
| J0402 |
| J0576 |
| J0688 |
| J0799* |
| J0873 |
| J1412 |
| J1596 |
| J1939 |
| J2404 |
| J2508 |
| J2679 |
| J2799 |
| J3401 |
| J3425 |
| J9052 |
| J9072 |
| J9172 |
| J9255 |
| J9258 |
| J9286 |
| J9321 |
| J9324 |
| J9333 |
| J9334 |
| L3161 |
| L5615 |
| L5926 |
| Q4279 |
| Q4287 |
| Q4288 |
| Q4289 |
| Q4290 |
| Q4291 |
| Q4292 |
| Q4293 |
| Q4294 |
| Q4295 |
| Q4296 |
| Q4297 |
| Q4298 |
| Q4299 |
| Q4300 |
| Q4301 |
| Q4302 |
| Q4303 |
| Q4304 |
EXPERIMENTAL/INVESTIGATIONAL
| 27278 |
| 31242 |
| 31243 |
| 33276 |
| 33277 |
| 33278 |
| 33279 |
| 33280 |
| 33281 |
| 33287 |
| 33288 |
| 52284 |
| 64596 |
| 64597 |
| 64598 |
| 81462 |
| 81463 |
| 81464 |
| 81517 |
| 90683 |
| 92972 |
| 93150 |
| 93151 |
| 93152 |
| 93153 |
| 97037 |
| 0420U |
| 0421U |
| 0422U |
| 0423U |
| 0424U |
| 0427U |
| 0428U |
| 0430U |
| 0431U |
| 0432U |
| 0433U |
| 0434U |
| 0435U |
| 0436U |
| 0437U |
| 0438U |
| 0811T |
| 0812T |
| 0813T |
| 0814T |
| 0815T |
| 0816T |
| 0817T |
| 0818T |
| 0819T |
| 0820T |
| 0821T |
| 0822T |
| 0823T |
| 0825T |
| 0826T |
| 0827T |
| 0828T |
| 0829T |
| 0830T |
| 0831T |
| 0832T |
| 0833T |
| 0834T |
| 0835T |
| 0836T |
| 0837T |
| 0838T |
| 0839T |
| 0840T |
| 0841T |
| 0842T |
| 0843T |
| 0844T |
| 0845T |
| 0846T |
| 0847T |
| 0848T |
| 0849T |
| 0850T |
| 0851T |
| 0852T |
| 0853T |
| 0854T |
| 0855T |
| 0856T |
| 0857T |
| 0858T |
| 0859T |
| 0860T |
| 0861T |
| 0862T |
| 0863T |
| 0864T |
| 0865T |
| 0866T |
| A4540 |
| A4541 |
| A4542 |
| C1600 |
| C1601 |
| C1602 |
| C1603 |
| C1604 |
| E0492 |
| E0493 |
| E0530 |
| E0678 |
| E0679 |
| E0680 |
| E0681 |
| E0682 |
| E0732 |
| E0733 |
| E0734 |
| E0735 |
| E3000 |
| J1304 |
J1413
|
NON-COVERED
| A7023 |
E1301
|
| J0750* |
| J0751* |
J1105
|
| Q0516* |
| Q0517* |
Q0518*
|
Q5132
|
NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT
| 99459 |
| A9609 |
| G0019 |
| G0022 |
| G0023 |
| G0024 |
| G0136 |
| G0140 |
G0146
|
NOT ELIGIBLE FOR REIMBURSEMENT
| G9886 |
| G9887 |
| G9888 |
| M1211 |
| M1212 |
| M1213 |
| M1214 |
| M1215 |
| M1216 |
| M1217 |
| M1218 |
| M1219 |
| M1220 |
| M1221 |
| M1222 |
| M1223 |
| M1224 |
| M1225 |
| M1226 |
| M1227 |
| M1228 |
| M1229 |
| M1230 |
| M1231 |
| M1232 |
| M1233 |
| M1234 |
| M1235 |
| M1236 |
| M1237 |
| M1238 |
| M1239 |
| M1240 |
| M1241 |
| M1242 |
| M1243 |
| M1244 |
| M1245 |
| M1246 |
| M1247 |
| M1248 |
| M1249 |
| M1250 |
| M1251 |
| M1252 |
| M1253 |
| M1254 |
| M1255 |
| M1256 |
| M1257 |
| M1258 |
| M1259 |
| M1260 |
| M1261 |
| M1262 |
| M1263 |
| M1264 |
| M1265 |
| M1266 |
| M1267 |
| M1268 |
| M1269 |
| M1270 |
| M1271 |
| M1272 |
| M1273 |
| M1274 |
| M1275 |
| M1276 |
| M1277 |
| M1278 |
| M1279 |
| M1280 |
| M1281 |
| M1282 |
| M1283 |
| M1284 |
| M1285 |
| M1286 |
| M1287 |
| M1288 |
| M1289 |
| M1290 |
| M1291 |
| M1292 |
| M1293 |
| M1294 |
| M1295 |
| M1296 |
| M1297 |
| M1298 |
| M1299 |
| M1300 |
| M1301 |
| M1302 |
| M1303 |
| M1304 |
| M1305 |
| M1306 |
| M1307 |
| M1308 |
| M1309 |
| M1310 |
| M1311 |
| M1312 |
| M1313 |
| M1314 |
| M1315 |
| M1316 |
| M1317 |
| M1318 |
| M1319 |
| M1320 |
| M1321 |
| M1322 |
| M1323 |
| M1324 |
| M1325 |
| M1326 |
| M1327 |
| M1328 |
| M1329 |
| M1330 |
| M1331 |
| M1332 |
| M1333 |
| M1334 |
| M1335 |
| M1336 |
| M1337 |
| M1338 |
| M1339 |
| M1340 |
| M1341 |
| M1342 |
| M1343 |
| M1344 |
| M1345 |
| M1346 |
| M1347 |
| M1348 |
| M1349 |
| M1350 |
| M1351 |
| M1352 |
| M1353 |
| M1354 |
| M1355 |
| M1356 |
| M1357 |
| M1358 |
| M1359 |
| M1360 |
| M1361 |
| M1362 |
| M1363 |
| M1364 |
| M1365 |
| M1366 |
| M1367 |
| M1368 |
| M1369 |
M1370
|
*Procedure Code effective 1/02/2024
