C96.4 coverage policies: Medicare and commercial payers

75 active Medicare policies list C96.4, and 4 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 C96.4

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-L34417

CT of the Head

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34417

CT of the Head

JM · Effective Oct 1, 2015

LCD · NGS-J6-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

JK · Effective Oct 1, 2015

LCD · NGS-J6-L40333

Erythropoiesis Stimulating Agents

LCD · NGS-J6-L40334

Erythropoiesis Stimulating Agents

J6 · Effective Jul 15, 2026

Commercial payer policies listing C96.4

4 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 C96.4, with the code’s status in each
Policy	Effective	Status of C96.4
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
PlerixaforPayerPolicy · AETNA-CPB-0779	Jan 9, 2024	Covered
Tumor MarkersPayerPolicy · AETNA-CPB-0352	Mar 5, 2024	Covered