C92.11 coverage policies: Medicare and commercial payers

65 active Medicare policies list C92.11, 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 C92.11

LCD · NOVITAS-JH-L35396

Biomarkers for Oncology

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35396

Biomarkers for Oncology

JL · Effective Oct 1, 2015

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 · 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

Commercial payer policies listing C92.11

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 C92.11, with the code’s status in each
Policy	Effective	Status of C92.11
Hematopoietic Cell Transplantation for Chronic Myelogenous LeukemiaPayerPolicy · AETNA-CPB-0674	Sep 19, 2023	Covered

Cigna

Cigna policies listing C92.11, with the code’s status in each
Policy	Effective	Status of C92.11
Serum Folate and Red Blood Cell Folate TestingPayerPolicy · CIGNA-0567	Dec 15, 2025	Covered