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01/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products

Purpose

The intent of this document is to communicate Medicare Advantage Product coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 1/01/2025, unless otherwise noted.

For more information related to these services, please refer to specific policies when applicable.​​​​​​


Coverage Statement

As a result of the Quarterly Code Update process, the following services have been reviewed; coverage determinations made by the Company are identified below. The procedure codes that represent these services will be effective on 1/01/2025.


Coding

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
0523U
0527U
0528U
0908T
0909T
0910T
0911T
0912T
A9615
C1737
C7562
C7564
C7565
C8001
C8002
C9173
C9804
E1803
E1804
E1807
E1808
E1813
E1814
E1826
E1827
E1828
E1829
G0560
G0562
G0563
G0564
G0565
J0601
J0602
J0603
J0605
J0607
J0608
J0609
J0615
J0666
J0870
J0901
J1307
J1414
J1552
J2290
J2472
J2802
J3392
J7601
J9026
J9028
J9076
J9292
Q5139
Q5140
Q5141
Q5142
Q5143
Q5144
Q5145
Q5146
Q9996
Q9997
Q9998




EXPERIMENTAL/INVESTIGATIONALSERVICES


(Experimental/Investigational positions are currently under review and will be finalized on 01/16/2025 with a retro-effective date of 01/01/2025)

51721
53865
53866
55881
55882
60660
60661
64466
64467
64468
64469
64473
64474
66683
81195
81558
82233
82234
83884
84393
84394
90593
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
C7563
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


38225
38226
38227
G0537
G0538
G0539
G0540
G0541
G0542
G0543
G0544
G0545
G0556
G0557
G0558
G0559



NOT ELIGIBLE FOR REIMBURSEMENT


98000
98001
98002
98003
98004
98005
98006
98007
98008
98009
98010
98011
98012
98013
98014
98015
98016
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



NOT-COVERED SERVICES


H0052
H0053
J0139
J7514
Q0155

 



01/14/2025
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