D04.121 coverage policies: Medicare and commercial payers

104 active Medicare policies list D04.121, 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.

Get free alerts for D04.121

Free account. Policy pages stay open to everyone.

Medicare policies listing D04.121

Showing 100 of 104

LCD · NORIDIAN-JE-L34233

Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34233

Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

JF · Effective Oct 1, 2015

LCD · CGS-J15-L33944

Blepharoplasty

J15 · Effective Oct 1, 2015

LCD · WPS-J5-L34528

Blepharoplasty, Blepharoptosis and Brow Lift

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L34528

Blepharoplasty, Blepharoptosis and Brow Lift

J8 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34411

Blepharoplasty, Eyelid Surgery, and Brow Lift

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34411

Blepharoplasty, Eyelid Surgery, and Brow Lift

JM · 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

Commercial payer policies listing D04.121

1 policy from 1 payer

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

Ambetter

Ambetter policies listing D04.121, with the code’s status in each
Policy	Effective	Status of D04.121
External Ocular PhotographyPayerPolicy · AMBETTER-CP-VP-43	Not recorded	Covered