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01/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products (Updated January 26, 2024; Retroactively Effective January 1, 2024)


Purpose

The intent of this document is to communicate Medicare Advantage Product coverage determinations for services identified through the Quarterly Code Update process. Procedure codes that represent these services are retroactively effective to 01/01/2024, unless otherwise noted. ​​ 

This communication has been updated to address the revised coverage position for CPT codes 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 93150, 93151, 93152, and 93153 from Experimental/Investigational to Eligible retroactively effective to 1/01/2024​. 

This communication, addressing 01/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products, replaces the version that was published on January 1, 2024.

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 are retroactively effective to 01/01/2024, unless otherwise noted.

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
33276
33277
33278
33279
33280
33281
33287
33288
58580
61889
61891
61892
67516
75580
76984
76987
76988
76989
81457
81458
81459
82166
86041
86042
86043
86366
87523
90589 
90623
92622
92623
93150
93151
93152
93153
93584 
93585
93586
93587
93588
96547
96548
0425U
0426U
0429U
0784T
0785T
0786T
0787T
0788T
0789T 
0815T
A4287
A4457
A4468
A6520
A6521
A6522
A6523
A6524
A6525
A6526
A6527
A6528
A6529
A6552
A6553
A6554
A6555
A6556
A6557
A6558
A6559
A6560
A6561
A6562
A6563
A6564
A6565
A6566
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
L5926
Q4279
Q4287
Q4288
Q4289
Q4290
Q4291
Q4292
Q4293
Q4294
Q4295
Q4296
Q4297
Q4298
Q4299
Q4300
Q4301
Q4302
Q4303
Q4304

EXPERIMENTAL/INVESTIGATIONAL

22836
22837
22838
27278
31242
31243
52284
64596
64597
64598
​81462
​81463

​81464


81517 
90683
92972
97037
0420U
0421U
0422U
0423U
0424U
0427U
0428U
0430U
0431U
0432U
0433U
0434U
0435U
0436U
0437U
0438U
0790T
0811T
0812T
0813T
0814T
0816T
0817T
0818T
0819T
0820T
0821T
0822T
​0823T

​0824T

​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
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
L5615

NON-COVERED
A7023
E1301
J0750*
J0751*
Q0516*
​J1105

Q0517*
Q0518*
Q5132

NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT

97550 
97551
97552
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​

01/26/2024