19 commercial payer policies list 76391. 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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19 policies from 12 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 76391 |
|---|---|---|
| Breast Transillumination, Electrical Impedance Scanning (EIS), and Elastography | Dec 5, 2023 | Covered |
| Liver Transplantation | Aug 9, 2023 | Covered |
| Non-Invasive Fetal Membranes Rupture Tests | Oct 17, 2023 | Covered |
| Noninvasive Tests for Hepatic Fibrosis | Feb 20, 2024 | Covered |
| Sialolithiasis (Salivary Stones) | Oct 10, 2023 | Covered |
| Policy | Effective | Status of 76391 |
|---|
| Imaging of the Abdomen and Pelvis | Apr 4, 2026 | Covered |
|---|---|---|
| Imaging of the Abdomen and Pelvis [for Amerigroup Georgia Medicaid] | Mar 23, 2025 | Covered |
| Policy | Effective | Status of 76391 |
|---|---|---|
| Cigna Commercial Radiology Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 76391 |
|---|---|---|
| Cigna Commercial & Medicare Cardiology & Radiology Code List | Jan 1, 2026 | Prior auth required |
| Cigna OBM Radiology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 76391 |
|---|---|---|
| GHI/Emblem Non-City of New York & Medicare Radiology and Cardiology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 76391 |
|---|---|---|
| EOCCO Cardiology & Radiology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 76391 |
|---|---|---|
| Health Alliance Plan Radiology Code List | Aug 1, 2026 | Prior auth required |
| Policy | Effective | Status of 76391 |
|---|---|---|
| Health Partners Plans Cardiology, Radiology, and Ultrasound Code List | Jul 1, 2025 | Prior auth required |
| Policy | Effective | Status of 76391 |
|---|---|---|
| Breast Imaging for Screening and Diagnosing Cancer | Feb 1, 2026 | Covered |
| Policy | Effective | Status of 76391 |
|---|---|---|
| The Health Plan Cardiology & Radiology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 76391 |
|---|---|---|
| Breast Imaging for Screening and Diagnosing Cancer | Feb 1, 2026 | Covered |
| Policy | Effective | Status of 76391 |
|---|---|---|
| Breast Imaging for Screening and Diagnosing Cancer | Feb 1, 2026 | Covered |