D04.122 coverage policies: Medicare and commercial payers

104 active Medicare policies list D04.122, 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 D04.122

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 D04.122

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 D04.122, with the code’s status in each
Policy	Effective	Status of D04.122
External Ocular PhotographyPayerPolicy · AMBETTER-CP-VP-43	Not recorded	Covered