About this policy
Jurisdiction: JL MAC Part B. States: Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania. 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 |
|---|---|---|
| 95782 | CPT | Covered |
| 95783 | CPT | Covered |
| 95800 | CPT | Covered |
| 95801 | CPT | Covered |
| 95805 | CPT | Covered |
| 95806 | CPT | Covered |
| 95807 | CPT | Covered |
| 95808 | CPT | Covered |
| 95810 | CPT | Covered |
| 95811 | CPT | Covered |
| 95999 | CPT | Covered |
| G0398 | HCPCS | Covered |
| G0399 | HCPCS | Covered |
| G0400 | HCPCS | Covered |
| E66.2 | ICD10CM | Covered |
| F10.182 | ICD10CM | Covered |
| F10.282 | ICD10CM | Covered |
| F10.982 | ICD10CM | Covered |
| F11.182 | ICD10CM | Covered |
| F11.282 | ICD10CM | Covered |
| F11.982 | ICD10CM | Covered |
| F13.182 | ICD10CM | Covered |
| F13.282 | ICD10CM | Covered |
| F13.982 | ICD10CM | Covered |
| F14.182 | ICD10CM | Covered |
| F14.282 | ICD10CM | Covered |
| F14.982 | ICD10CM | Covered |
| F15.182 | ICD10CM | Covered |
| F15.282 | ICD10CM | Covered |
| F15.982 | ICD10CM | Covered |
| F19.182 | ICD10CM | Covered |
| F19.21 | ICD10CM | Covered |
| F19.282 | ICD10CM | Covered |
| F19.982 | ICD10CM | Covered |
| F51.01 | ICD10CM | Covered |
| F51.02 | ICD10CM | Covered |
| F51.03 | ICD10CM | Covered |
| F51.09 | ICD10CM | Covered |
| F51.11 | ICD10CM | Covered |
| F51.12 | ICD10CM | Covered |
| F51.13 | ICD10CM | Covered |
| F51.19 | ICD10CM | Covered |
| F51.3 | ICD10CM | Covered |
| F51.4 | ICD10CM | Covered |
| F51.5 | ICD10CM | Covered |
| F51.8 | ICD10CM | Covered |
| G47.10 | ICD10CM | Covered |
| G47.11 | ICD10CM | Covered |
| G47.12 | ICD10CM | Covered |
| G47.13 | ICD10CM | Covered |
| G47.14 | ICD10CM | Covered |
| G47.19 | ICD10CM | Covered |
| G47.20 | ICD10CM | Covered |
| G47.21 | ICD10CM | Covered |
| G47.22 | ICD10CM | Covered |
| G47.23 | ICD10CM | Covered |
| G47.24 | ICD10CM | Covered |
| G47.25 | ICD10CM | Covered |
| G47.26 | ICD10CM | Covered |
| G47.27 | ICD10CM | Covered |
| G47.29 | ICD10CM | Covered |
| G47.30 | ICD10CM | Covered |
| G47.31 | ICD10CM | Covered |
| G47.32 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| G47.34 | ICD10CM | Covered |
| G47.35 | ICD10CM | Covered |
| G47.36 | ICD10CM | Covered |
| G47.39 | ICD10CM | Covered |
| G47.411 | ICD10CM | Covered |
| G47.419 | ICD10CM | Covered |
| G47.421 | ICD10CM | Covered |
| G47.429 | ICD10CM | Covered |
| G47.50 | ICD10CM | Covered |
| G47.51 | ICD10CM | Covered |
| G47.52 | ICD10CM | Covered |
| G47.53 | ICD10CM | Covered |
| G47.54 | ICD10CM | Covered |
| G47.59 | ICD10CM | Covered |
| G47.61 | ICD10CM | Covered |
| G47.69 | ICD10CM | Covered |
| G47.8 | ICD10CM | Covered |
| N52.01 | ICD10CM | Covered |
| N52.02 | ICD10CM | Covered |
| N52.03 | ICD10CM | Covered |
| N52.1 | ICD10CM | Covered |
| N52.2 | ICD10CM | Covered |
| N52.31 | ICD10CM | Covered |
| N52.32 | ICD10CM | Covered |
| N52.33 | ICD10CM | Covered |
| N52.34 | ICD10CM | Covered |
| N52.35 | ICD10CM | Covered |
| N52.36 | ICD10CM | Covered |
| N52.37 | ICD10CM | Covered |
| N52.39 | ICD10CM | Covered |
| N52.8 | ICD10CM | Covered |
| N52.9 | ICD10CM | Covered |