C69.00 coverage policies: Medicare and commercial payers

75 active Medicare policies list C69.00, and 5 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 C69.00

LCD · PALMETTO-JJ-L34415

CT of the Abdomen and Pelvis

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34415

CT of the Abdomen and Pelvis

JM · 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 · NORIDIAN-JE-L34215

Lab: Flow Cytometry

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34215

Lab: Flow Cytometry

JF · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34513

Lab: Flow Cytometry

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34513

Lab: Flow Cytometry

JM · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L38972

MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

JE · Effective Aug 8, 2022

LCD · NORIDIAN-JF-L38972

MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

Commercial payer policies listing C69.00

5 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 C69.00, with the code’s status in each
Policy	Effective	Status of C69.00
Anterior Segment Scanning Computerized Ophthalmic Diagnostic ImagingPayerPolicy · AETNA-CPB-0749	Oct 6, 2023	Covered
Intraoperative Radiation Therapy (IORT)PayerPolicy · AETNA-CPB-0721	Sep 22, 2023	Covered
Proton Beam, Neutron Beam, and Carbon Ion RadiotherapyPayerPolicy · AETNA-CPB-0270	Oct 3, 2023	Covered

Anthem

Anthem policies listing C69.00, with the code’s status in each
Policy	Effective	Status of C69.00
Fundus PhotographyClinical Guideline · ANTHEM-CG-MED-47	Apr 15, 2026	Covered
Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses