C83.00 coverage policies: Medicare and commercial payers

88 active Medicare policies list C83.00, 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 C83.00

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 C83.00

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 C83.00, with the code’s status in each
Policy	Effective	Status of C83.00
Bortezomib ProductsPayerPolicy · AETNA-CPB-0675	Feb 2, 2024	Covered
Ibritumomab Tiuxetan (Zevalin)PayerPolicy · AETNA-CPB-0659	Oct 11, 2023	Covered
PlerixaforPayerPolicy · AETNA-CPB-0779	Jan 9, 2024	Covered
Tumor MarkersPayerPolicy · AETNA-CPB-0352	Mar 5, 2024	Covered

Anthem

Anthem policies listing C83.00, with the code’s status in each
Policy	Effective	Status of C83.00
Donor Lymphocyte Infusion for Hematologic Malignancies after Allogeneic Hematopoietic Progenitor Cell TransplantationClinical Guideline · ANTHEM-CG-TRANS-03