C04.9 coverage policies: Medicare and commercial payers

89 active Medicare policies list C04.9, and 3 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 C04.9

LCD · PALMETTO-JJ-L33457

Cardiac Radionuclide Imaging

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33457

Cardiac Radionuclide Imaging

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33459

Computerized Axial Tomography (CT), Thorax

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33459

Computerized Axial Tomography (CT), Thorax

JM · Effective Oct 1, 2015

LCD · NGS-J6-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

JK · Effective Oct 1, 2015

LCD · CGS-J15-L34356

Erythropoiesis Stimulating Agents (ESA)

J15 · Effective Oct 1, 2015

LCD · CGS-J15-L40386

Erythropoiesis Stimulating Agents (ESA)

J15

LCD · FIRST_COAST-L33818

Excision of Malignant Skin Lesions

J9 · Effective Oct 1, 2015

LCD · NGS-J6-L37810

Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

Commercial payer policies listing C04.9

3 policies from 2 payers

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

Aetna

Aetna policies listing C04.9, with the code’s status in each
Policy	Effective	Status of C04.9
Mohs Micrographic SurgeryPayerPolicy · AETNA-CPB-0383	Jun 22, 2023	Covered
Speech TherapyPayerPolicy · AETNA-CPB-0243	Oct 24, 2023	Covered

Cigna

Cigna policies listing C04.9, with the code’s status in each
Policy	Effective	Status of C04.9
Low-Level Laser and High-Power Laser TherapyPayerPolicy · CIGNA-CPG030	Mar 15, 2026	Covered