D04.22 coverage policies: Medicare and commercial payers

88 active Medicare policies list D04.22, 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 D04.22

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 · 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-L33428

Cosmetic and Reconstructive Surgery

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33428

Cosmetic and Reconstructive Surgery

JM · Effective Oct 1, 2015

LCD · FIRST_COAST-L33813

Destruction of Malignant Skin Lesions

J9 · Effective Oct 1, 2015

LCD · NGS-J6-L40333

Commercial payer policies listing D04.22

1 policy from 1 payer

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

Aetna

Aetna policies listing D04.22, with the code’s status in each
Policy	Effective	Status of D04.22
Intraoperative Neurophysiological MonitoringPayerPolicy · AETNA-CPB-0697	Oct 26, 2023	Covered