C40.92 coverage policies: Medicare and commercial payers

86 active Medicare policies list C40.92, and 2 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 C40.92

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-L34037

Flow Cytometry

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L37810

Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

J6 · Effective Apr 1, 2019

LCD · NGS-JK-L37810

Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

JK · Effective Apr 1, 2019

LCD · PALMETTO-JJ-L33461

Commercial payer policies listing C40.92

2 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 C40.92, with the code’s status in each
Policy	Effective	Status of C40.92
Proton Beam, Neutron Beam, and Carbon Ion RadiotherapyPayerPolicy · AETNA-CPB-0270	Oct 3, 2023	Covered

Anthem

Anthem policies listing C40.92, with the code’s status in each
Policy	Effective	Status of C40.92
Hematopoietic Stem Cell Transplantation for Pediatric Solid TumorsPayerPolicy · ANTHEM-TRANS.00027	Jan 6, 2026	Covered