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 |
|---|---|---|
| 36005 | CPT | Covered |
| 36010 | CPT | Covered |
| 36140 | CPT | Covered |
| 36215 | CPT | Covered |
| 36216 | CPT | Covered |
| 36217 | CPT | Covered |
| 36218 | CPT | Covered |
| 36245 | CPT | Covered |
| 36246 | CPT | Covered |
| 36247 | CPT | Covered |
| 36593 | CPT | Covered |
| 36831 | CPT | Covered |
| 36832 | CPT | Covered |
| 36833 | CPT | Covered |
| 36901 | CPT | Covered |
| 36902 | CPT | Covered |
| 36903 | CPT | Covered |
| 36904 | CPT | Covered |
| 36905 | CPT | Covered |
| 36906 | CPT | Covered |
| 36907 | CPT | Covered |
| 37186 | CPT | Covered |
| 37211 | CPT | Covered |
| 37212 | CPT | Covered |
| 37213 | CPT | Covered |
| 37214 | CPT | Covered |
| 37236 | CPT | Covered |
| 37237 | CPT | Covered |
| 37246 | CPT | Covered |
| 37247 | CPT | Covered |
| 37248 | CPT | Covered |
| 37249 | CPT | Covered |
| 75710 | CPT | Covered |
| 75820 | CPT | Covered |
| 75822 | CPT | Covered |
| 75825 | CPT | Covered |
| 75827 | CPT | Covered |
| 93990 | CPT | Covered |
| I70.401 | ICD10CM | Covered |
| I70.402 | ICD10CM | Covered |
| I70.403 | ICD10CM | Covered |
| I70.408 | ICD10CM | Covered |
| I70.411 | ICD10CM | Covered |
| I70.412 | ICD10CM | Covered |
| I70.413 | ICD10CM | Covered |
| I70.418 | ICD10CM | Covered |
| I70.421 | ICD10CM | Covered |
| I70.422 | ICD10CM | Covered |
| I70.423 | ICD10CM | Covered |
| I70.428 | ICD10CM | Covered |
| I70.431 | ICD10CM | Covered |
| I70.432 | ICD10CM | Covered |
| I70.433 | ICD10CM | Covered |
| I70.434 | ICD10CM | Covered |
| I70.435 | ICD10CM | Covered |
| I70.441 | ICD10CM | Covered |
| I70.442 | ICD10CM | Covered |
| I70.443 | ICD10CM | Covered |
| I70.444 | ICD10CM | Covered |
| I70.445 | ICD10CM | Covered |
| I70.45 | ICD10CM | Covered |
| I70.461 | ICD10CM | Covered |
| I70.462 | ICD10CM | Covered |
| I70.463 | ICD10CM | Covered |
| I70.468 | ICD10CM | Covered |
| I70.491 | ICD10CM | Covered |
| I70.492 | ICD10CM | Covered |
| I70.493 | ICD10CM | Covered |
| I70.498 | ICD10CM | Covered |
| I70.501 | ICD10CM | Covered |
| I70.502 | ICD10CM | Covered |
| I70.503 | ICD10CM | Covered |
| I70.508 | ICD10CM | Covered |
| I70.511 | ICD10CM | Covered |
| I70.512 | ICD10CM | Covered |
| I70.513 | ICD10CM | Covered |
| I70.518 | ICD10CM | Covered |
| I70.521 | ICD10CM | Covered |
| I70.522 | ICD10CM | Covered |
| I70.523 | ICD10CM | Covered |
| I70.528 | ICD10CM | Covered |
| I70.531 | ICD10CM | Covered |
| I70.532 | ICD10CM | Covered |
| I70.533 | ICD10CM | Covered |
| I70.534 | ICD10CM | Covered |
| I70.535 | ICD10CM | Covered |
| I70.541 | ICD10CM | Covered |
| I70.542 | ICD10CM | Covered |
| I70.543 | ICD10CM | Covered |
| I70.544 | ICD10CM | Covered |
| I70.545 | ICD10CM | Covered |
| I70.55 | ICD10CM | Covered |
| I70.561 | ICD10CM | Covered |
| I70.562 | ICD10CM | Covered |
| I70.563 | ICD10CM | Covered |
| I70.568 | ICD10CM | Covered |
| I70.591 | ICD10CM | Covered |
| I70.592 | ICD10CM | Covered |
| I70.593 | ICD10CM | Covered |
| I70.598 | ICD10CM | Covered |
| I72.1 | ICD10CM | Covered |
| I72.4 | ICD10CM | Covered |
| I74.2 | ICD10CM | Covered |
| I74.3 | ICD10CM | Covered |
| I77.0 | ICD10CM | Covered |
| I77.1 | ICD10CM | Covered |
| I80.8 | ICD10CM | Covered |
| I82.611 | ICD10CM | Covered |
| I82.612 | ICD10CM | Covered |
| I82.613 | ICD10CM | Covered |
| I87.1 | ICD10CM | Covered |
| I97.89 | ICD10CM | Covered |
| M79.89 | ICD10CM | Covered |
| N18.6 | ICD10CM | Covered |
| T82.310A | ICD10CM | Covered |
| T82.311A | ICD10CM | Covered |
| T82.312A | ICD10CM | Covered |
| T82.318A | ICD10CM | Covered |
| T82.320A | ICD10CM | Covered |
| T82.321A | ICD10CM | Covered |
| T82.322A | ICD10CM | Covered |
| T82.328A | ICD10CM | Covered |
| T82.330A | ICD10CM | Covered |
| T82.331A | ICD10CM | Covered |
| T82.332A | ICD10CM | Covered |
| T82.338A | ICD10CM | Covered |
| T82.390A | ICD10CM | Covered |
| T82.391A | ICD10CM | Covered |
| T82.392A | ICD10CM | Covered |
| T82.398A | ICD10CM | Covered |
| T82.41XA | ICD10CM | Covered |
| T82.42XA | ICD10CM | Covered |
| T82.43XA | ICD10CM | Covered |
| T82.49XA | ICD10CM | Covered |
| T82.510A | ICD10CM | Covered |
| T82.511A | ICD10CM | Covered |
| T82.513A | ICD10CM | Covered |
| T82.514A | ICD10CM | Covered |
| T82.515A | ICD10CM | Covered |
| T82.518A | ICD10CM | Covered |
| T82.520A | ICD10CM | Covered |
| T82.521A | ICD10CM | Covered |
| T82.523A | ICD10CM | Covered |
| T82.524A | ICD10CM | Covered |
| T82.525A | ICD10CM | Covered |
| T82.528A | ICD10CM | Covered |
| T82.529A | ICD10CM | Covered |
| T82.530A | ICD10CM | Covered |
| T82.531A | ICD10CM | Covered |
| T82.533A | ICD10CM | Covered |
| T82.534A | ICD10CM | Covered |
| T82.535A | ICD10CM | Covered |
| T82.538A | ICD10CM | Covered |
| T82.590A | ICD10CM | Covered |
| T82.591A | ICD10CM | Covered |
| T82.593A | ICD10CM | Covered |
| T82.594A | ICD10CM | Covered |
| T82.595A | ICD10CM | Covered |
| T82.598A | ICD10CM | Covered |
| T82.7XXA | ICD10CM | Covered |
| T82.818A | ICD10CM | Covered |
| T82.818S | ICD10CM | Covered |
| T82.828A | ICD10CM | Covered |
| T82.828S | ICD10CM | Covered |
| T82.838A | ICD10CM | Covered |
| T82.838S | ICD10CM | Covered |
| T82.848A | ICD10CM | Covered |
| T82.848S | ICD10CM | Covered |
| T82.858A | ICD10CM | Covered |
| T82.858S | ICD10CM | Covered |
| T82.868A | ICD10CM | Covered |
| T82.868S | ICD10CM | Covered |
| T82.898A | ICD10CM | Covered |
| T82.898S | ICD10CM | Covered |
| Z99.2 | ICD10CM | Covered |