C84.0A coverage policies: Medicare and commercial payers

62 active Medicare policies list C84.0A, and 1 commercial payer policy lists 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 C84.0A

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 · 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 · PALMETTO-JJ-L34417

CT of the Head

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34417

CT of the Head

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33461

Implantable Infusion Pump

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33461

Implantable Infusion Pump

JM · 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

Commercial payer policies listing C84.0A

1 policy from 1 payer

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

Anthem

Anthem policies listing C84.0A, with the code’s status in each
Policy	Effective	Status of C84.0A
Ultraviolet Light Therapy Delivery Devices for Home UseClinical Guideline · ANTHEM-CG-DME-41	Oct 1, 2026	Covered