C81.00 coverage policies: Medicare and commercial payers

82 active Medicare policies list C81.00, and 14 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 C81.00

LCD · NGS-J6-L39513

Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin

J6 · Effective Aug 1, 2023

LCD · NGS-JK-L39513

Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin

JK · Effective Aug 1, 2023

LCD · CGS-J15-L39434

Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

J15 · Effective Feb 19, 2023

LCD · NORIDIAN-JE-L39396

Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

JE · Effective Mar 5, 2023

LCD · NORIDIAN-JF-L39396

Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

JF · Effective Mar 5, 2023

LCD · PALMETTO-JJ-L39270

Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

JJ · Effective Sep 4, 2022

LCD · PALMETTO-JM-L39270

Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

JM · Effective Sep 4, 2022

LCD · WPS-J5-L39477

Commercial payer policies listing C81.00

14 policies from 3 payers

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

Aetna

Showing 10 of 11 · All Aetna policies

Aetna policies listing C81.00, with the code’s status in each
Policy	Effective	Status of C81.00
BrachytherapyPayerPolicy · AETNA-CPB-0371	Jun 6, 2023	Covered
Cerebral Perfusion StudiesPayerPolicy · AETNA-CPB-0663	Sep 14, 2023	Covered
Double Balloon EnteroscopyPayerPolicy · AETNA-CPB-0737	Feb 20, 2024	Covered
Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase FractionPayerPolicy · AETNA-CPB-0351	Jun 5, 2023	Covered
Gonadotropin-Releasing Hormone Analogs and AntagonistsPayerPolicy · AETNA-CPB-0501	Jul 14, 2023	Covered
Hematopoietic Cell Transplantation for Hodgkin's DiseasePayerPolicy · AETNA-CPB-0495	Jul 12, 2023

Policy	Effective	Status of C81.00
Cellular Therapy Products for Allogeneic Stem Cell TransplantationPayerPolicy · ANTHEM-MED.00147	Oct 1, 2026	Covered
Donor Lymphocyte Infusion for Hematologic Malignancies after Allogeneic Hematopoietic Progenitor Cell TransplantationClinical Guideline · ANTHEM-CG-TRANS-03	Jul 1, 2026	Covered