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1/01/2025 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 SERVICES
| 15011 |
| 15012 |
| 15013 |
| 15014 |
| 15015 |
| 15016 |
| 15017 |
| 15018 |
| 25448 |
| 38228 |
| 49186 |
| 49187 |
| 49188 |
| 49189 |
| 49190 |
| 61715 |
| 76014 |
| 76015 |
| 76016 |
| 76017 |
| 76018 |
| 76019 |
| 81515 |
| 86581 |
| 87513 |
| 87564 |
| 87594 |
| 87626 |
| 92137 |
| 93896 |
| 93897 |
| 93898 |
| 96041 |
| 98000 |
| 98001 |
| 98002 |
| 98003 |
| 98004 |
| 98005 |
| 98006 |
| 98007 |
| 98008 |
| 98009 |
| 98010 |
| 98011 |
| 98012 |
| 98013 |
| 98014 |
| 98015 |
| 0523U |
| 0527U |
| 0528U |
| 0908T |
| 0909T |
| 0910T |
| 0911T |
| 0912T |
| A9615 |
| C1737 |
| C7562 |
| C7563 |
| C7564 |
| C7565 |
| C8001 |
| C8002 |
| C9173 |
| E1803 |
| E1804 |
| E1807 |
| E1808 |
| E1813 |
| E1814 |
| E1826 |
| E1827 |
| E1828 |
| E1829 |
| G0560 |
| G0562 |
| G0563 |
| G0564 |
| G0565 |
| J0139 |
| J0666 |
| J0870 |
| J1307 |
| J1414 |
| J1552 |
| J2290 |
| J2472 |
| J2802 |
| J3392 |
| J7601 |
| J9026 |
| J9028 |
| J9076 |
| J9292 |
| Q5139 |
| Q5140 |
| Q5141 |
| Q5142 |
| Q5143 |
| Q5144 |
| Q5145 |
| Q5146 |
| Q9996 |
| Q9997 |
Q9998
|
EXPERIMENTAL/INVESTIGATIONAL SERVICES
| 51721 |
| 53865 |
| 53866 |
| 55881 |
| 55882 |
| 60660 |
| 60661 |
| 64466 |
| 64467 |
| 64468 |
| 64469 |
| 64473 |
| 64474 |
| 66683 |
| 81195 |
| 81558 |
| 82233 |
| 82234 |
| 83884 |
| 84393 |
| 84394 |
| 0521U |
| 0522U |
| 0524U |
| 0525U |
| 0526U |
| 0529U |
| 0530U |
| 0901T |
| 0902T |
| 0903T |
| 0904T |
| 0905T |
| 0906T |
| 0907T |
| 0913T |
| 0914T |
| 0915T |
| 0916T |
| 0917T |
| 0918T |
| 0919T |
| 0920T |
| 0921T |
| 0922T |
| 0923T |
| 0924T |
| 0925T |
| 0926T |
| 0927T |
| 0928T |
| 0929T |
| 0930T |
| 0931T |
| 0932T |
| 0933T |
| 0934T |
| 0935T |
| 0936T |
| 0937T |
| 0938T |
| 0939T |
| 0940T |
| 0941T |
| 0942T |
| 0943T |
| 0944T |
| 0945T |
| 0946T |
| 0947T |
| C1735 |
| C1736 |
| C1738 |
| C1739 |
| C8003 |
| C9610 |
| C9806 |
| C9807 |
| C9808 |
| C9809 |
| E1822 |
| E1823 |
| G0552 |
| G0553 |
| G0554 |
| G0555 |
| G0561 |
| Q4346 |
| Q4347 |
| Q4348 |
| Q4349 |
| Q4350 |
| Q4351 |
| Q4352 |
Q4353
|
SERVICES NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT
| G0537 |
| G0538 |
| G0539 |
| G0540 |
| G0541 |
| G0542 |
| G0543 |
| G0544 |
| G0545 |
| G0556 |
| G0557 |
| G0558 |
G0559
|
SERVICES NOT ELIGIBLE FOR REIMBURSEMENT
| 38225 |
| 38226 |
| 38227 |
| 98016 |
| C9804 |
| G0532 |
| G0533 |
| G0534 |
| G0535 |
| G0536 |
| G0546 |
| G0547 |
| G0548 |
| G0549 |
| G0550 |
| G0551 |
| M1371 |
| M1372 |
| M1373 |
| M1374 |
| M1375 |
| M1376 |
| M1377 |
| M1378 |
| M1379 |
| M1380 |
| M1381 |
| M1382 |
| M1383 |
| M1384 |
| M1385 |
| M1386 |
| M1387 |
| M1388 |
| M1389 |
| M1390 |
| M1391 |
| M1392 |
| M1393 |
| M1394 |
| M1395 |
| M1396 |
| M1397 |
| M1398 |
| M1399 |
| M1400 |
| M1401 |
| M1402 |
| M1403 |
| M1404 |
| M1405 |
| M1406 |
| M1407 |
| M1408 |
| M1409 |
| M1410 |
| M1411 |
| M1412 |
| M1413 |
| M1414 |
| M1415 |
| M1416 |
| M1417 |
| M1418 |
| M1419 |
| M1420 |
| M1421 |
| M1422 |
| M1423 |
| M1424 |
| M1425 |
Q0521
|
NON-COVERED SERVICES
| 90593 |
| H0052 |
| H0053 |
| J0601 |
| J0602 |
| J0603 |
| J0605 |
| J0607 |
| J0608 |
| J0609 |
| J0615 |
| J0901 |
| J7514 |
Q0155
|
