2 commercial payer policies list 28750. 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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2 policies from 1 payer
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 28750 |
|---|---|---|
| General Requirements and Documentation | Nov 15, 2025 | Covered |
| Level of Care for Surgical Procedures | Nov 15, 2025 | Covered |