C94.80 coverage policies: Medicare and commercial payers

64 active Medicare policies list C94.80, and 3 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 C94.80

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

LCD · CGS-J15-L34037

Flow Cytometry

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L37606

Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

J6 · Effective Aug 1, 2018

Commercial payer policies listing C94.80

3 policies from 1 payer

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

Aetna

Aetna policies listing C94.80, with the code’s status in each
Policy	Effective	Status of C94.80
Dendritic Cell ImmunotherapyPayerPolicy · AETNA-CPB-0377	Jun 6, 2023	Covered
Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase FractionPayerPolicy · AETNA-CPB-0351	Jun 5, 2023	Covered
Polymerase Chain Reaction Testing: Selected IndicationsPayerPolicy · AETNA-CPB-0650	Feb 9, 2024	Covered