95851 coverage policies: Medicare and commercial payers

10 active Medicare policies list 95851, and 15 commercial payer policies list it. 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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Medicare policies listing 95851

LCD · CGS-J15-L34049

Outpatient Physical and Occupational Therapy Services

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L33631

Outpatient Physical and Occupational Therapy Services

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33631

Outpatient Physical and Occupational Therapy Services

JK · Effective Oct 1, 2015

Article · A53057

Billing and Coding: Home Health Occupational Therapy

National · Effective Oct 1, 2026

Article · A53058

Billing and Coding: Home Health Physical Therapy

National · Effective Oct 1, 2026

Article · A53064

Billing and Coding: Outpatient Occupational Therapy

National · Effective Oct 1, 2026

Article · A56566

Billing and Coding: Outpatient Physical and Occupational Therapy Services

J6 · Effective Apr 1, 2026

Article · A57067

Billing and Coding: Outpatient Physical and Occupational Therapy Services

National · Effective Jun 4, 2026

Article · A53065

Billing and Coding: Outpatient Physical Therapy

National · Effective Oct 1, 2026

Article · A57311

Billing and Coding: Physical Therapy - Home Health

Commercial payer policies listing 95851

15 policies from 8 payers

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Aetna

Aetna policies listing 95851, with the code’s status in each
Policy	Effective	Status of 95851
Knee Ligament Arthrometer TestingPayerPolicy · AETNA-CPB-0397	Jun 6, 2023	Covered
Musculoskeletal Assessment SystemsPayerPolicy · AETNA-CPB-0212	Mar 9, 2023	Covered

BCBS Illinois

BCBS Illinois policies listing 95851, with the code’s status in each
Policy	Effective	Status of 95851
Physical Therapy (PT) and Occupational Therapy (OT) ServicesPayerPolicy · BCBSIL-THE803.010	Jan 1, 2026	Covered
Temporomandibular Joint DisordersPayerPolicy · BCBSIL-SUR705.010	Jan 1, 2026	Covered

Policy	Effective	Status of 95851
Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluationsPayerPolicy · CIGNA-CPG111	Jul 15, 2026	Covered with conditions
Physical Performance Test or MeasurementPayerPolicy · CIGNA-CPG295	Nov 15, 2025	Covered with conditions

95851 coverage policies: Medicare and commercial payers

Medicare policies listing 95851

Outpatient Physical and Occupational Therapy Services

Outpatient Physical and Occupational Therapy Services

Outpatient Physical and Occupational Therapy Services

Billing and Coding: Home Health Occupational Therapy

Billing and Coding: Home Health Physical Therapy

Billing and Coding: Outpatient Occupational Therapy

Billing and Coding: Outpatient Physical and Occupational Therapy Services

Billing and Coding: Outpatient Physical and Occupational Therapy Services

Billing and Coding: Outpatient Physical Therapy

Billing and Coding: Physical Therapy - Home Health

Commercial payer policies listing 95851

Aetna

BCBS Illinois

BCBS Montana

95851 coverage policies: Medicare and commercial payers

Medicare policies listing 95851

Outpatient Physical and Occupational Therapy Services

Outpatient Physical and Occupational Therapy Services

Outpatient Physical and Occupational Therapy Services

Billing and Coding: Home Health Occupational Therapy

Billing and Coding: Home Health Physical Therapy

Billing and Coding: Outpatient Occupational Therapy

Billing and Coding: Outpatient Physical and Occupational Therapy Services

Billing and Coding: Outpatient Physical and Occupational Therapy Services

Billing and Coding: Outpatient Physical Therapy

Billing and Coding: Physical Therapy - Home Health

Commercial payer policies listing 95851

Aetna

BCBS Illinois

BCBS Montana

BCBS New Mexico

BCBS Oklahoma

Cigna

The Health Plan

EOCCO / Moda Health

Policy	Effective	Status of 95851
The Health Plan MSK Chiro Code ListPayerPolicy · EVICORE-HPLAN-THE_HEALTH_PLAN-051854AF1B9B	Jan 1, 2026	Prior auth required
The Health Plan MSK PTOT Code ListPayerPolicy · EVICORE-HPLAN-THE_HEALTH_PLAN-E178D78B53BA	Jan 1, 2026	Prior auth required