8 commercial payer policies list 21025. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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8 policies from 7 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 21025 |
|---|---|---|
| Cigna Commercial Other Services Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 21025 |
|---|---|---|
| Neuralgia Inducing Cavitational Osteonecrosis (NICO) and Ultrasonograph Bone Densitometer to Detect NICO | Sep 13, 2023 | Covered |
| Policy | Effective | Status of 21025 |
|---|---|---|
| Neuralgia Inducing Cavitational Osteonecrosis (NICO) | Apr 15, 2026 | Covered |
| Policy | Effective | Status of 21025 |
|---|---|---|
| Neuralgia Inducing Cavitational Osteonecrosis (NICO) | Apr 15, 2026 | Covered |
| Policy | Effective | Status of 21025 |
|---|---|---|
| Neuralgia Inducing Cavitational Osteonecrosis (NICO) | Apr 15, 2026 | Covered |
| Policy | Effective | Status of 21025 |
|---|---|---|
| Neuralgia Inducing Cavitational Osteonecrosis (NICO) | Apr 15, 2026 | Covered |
| Policy | Effective | Status of 21025 |
|---|---|---|
| Gender Affirming Interventions for Gender Dysphoria | Apr 1, 2026 | Covered |