About this policy
Jurisdiction: J15 MAC Part B. States: Kentucky, Ohio. Type: Active LCD
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 29065 | CPT | Covered |
| 29075 | CPT | Covered |
| 29085 | CPT | Covered |
| 29086 | CPT | Covered |
| 29105 | CPT | Covered |
| 29125 | CPT | Covered |
| 29126 | CPT | Covered |
| 29130 | CPT | Covered |
| 29131 | CPT | Covered |
| 29200 | CPT | Covered |
| 29240 | CPT | Covered |
| 29260 | CPT | Covered |
| 29280 | CPT | Covered |
| 29345 | CPT | Covered |
| 29355 | CPT | Covered |
| 29365 | CPT | Covered |
| 29405 | CPT | Covered |
| 29425 | CPT | Covered |
| 29445 | CPT | Covered |
| 29505 | CPT | Covered |
| 29515 | CPT | Covered |
| 29520 | CPT | Covered |
| 29530 | CPT | Covered |
| 29540 | CPT | Covered |
| 29550 | CPT | Covered |
| 29580 | CPT | Covered |
| 29581 | CPT | Covered |
| 29584 | CPT | Covered |
| 29799 | CPT | Covered |
| 90901 | CPT | Covered |
| 90912 | CPT | Covered |
| 90913 | CPT | Covered |
| 95851 | CPT | Covered |
| 95852 | CPT | Covered |
| 96125 | CPT | Covered |
| 97010 | CPT | Covered |
| 97012 | CPT | Covered |
| 97016 | CPT | Covered |
| 97018 | CPT | Covered |
| 97022 | CPT | Covered |
| 97024 | CPT | Covered |
| 97026 | CPT | Covered |
| 97028 | CPT | Covered |
| 97032 | CPT | Covered |
| 97033 | CPT | Covered |
| 97034 | CPT | Covered |
| 97035 | CPT | Covered |
| 97036 | CPT | Covered |
| 97039 | CPT | Covered |
| 97110 | CPT | Covered |
| 97112 | CPT | Covered |
| 97113 | CPT | Covered |
| 97116 | CPT | Covered |
| 97124 | CPT | Covered |
| 97129 | CPT | Covered |
| 97130 | CPT | Covered |
| 97139 | CPT | Covered |
| 97140 | CPT | Covered |
| 97150 | CPT | Covered |
| 97161 | CPT | Covered |
| 97162 | CPT | Covered |
| 97163 | CPT | Covered |
| 97164 | CPT | Covered |
| 97165 | CPT | Covered |
| 97166 | CPT | Covered |
| 97167 | CPT | Covered |
| 97168 | CPT | Covered |
| 97530 | CPT | Covered |
| 97533 | CPT | Covered |
| 97535 | CPT | Covered |
| 97537 | CPT | Covered |
| 97542 | CPT | Covered |
| 97597 | CPT | Covered |
| 97598 | CPT | Covered |
| 97602 | CPT | Covered |
| 97605 | CPT | Covered |
| 97606 | CPT | Covered |
| 97607 | CPT | Covered |
| 97608 | CPT | Covered |
| 97750 | CPT | Covered |
| 97755 | CPT | Covered |
| 97760 | CPT | Covered |
| 97761 | CPT | Covered |
| 97763 | CPT | Covered |
| 97799 | CPT | Covered |
| 98966 | CPT | Covered |
| 98967 | CPT | Covered |
| 98968 | CPT | Covered |
| 98970 | CPT | Covered |
| 98971 | CPT | Covered |
| 98972 | CPT | Covered |
| 98975 | CPT | Covered |
| 98976 | CPT | Covered |
| 98977 | CPT | Covered |
| 98980 | CPT | Covered |
| 98981 | CPT | Covered |
| G0281 | HCPCS | Covered |
| G0283 | HCPCS | Covered |
| G0329 | HCPCS | Covered |
| G2010 | HCPCS | Covered |
| G2250 | HCPCS | Covered |
| G2251 | HCPCS | Covered |