D17.71 coverage policies: Medicare and commercial payers

23 active Medicare policies list D17.71, and 2 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 D17.71

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

LCD · CGS-J15-L34005

Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15 · 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 · NOVITAS-JH-L35092

Diagnostic Abdominal Aortography and Renal Angiography

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35092

Diagnostic Abdominal Aortography and Renal Angiography

JL · Effective Oct 1, 2015

LCD · FIRST_COAST-L33583

Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33461

Commercial payer policies listing D17.71

2 policies from 2 payers

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

Aetna

Aetna policies listing D17.71, with the code’s status in each
Policy	Effective	Status of D17.71
Intraoperative Radiation Therapy (IORT)PayerPolicy · AETNA-CPB-0721	Sep 22, 2023	Covered

Anthem

Anthem policies listing D17.71, with the code’s status in each
Policy	Effective	Status of D17.71
Outpatient CystourethroscopyClinical Guideline · ANTHEM-CG-SURG-51	Jul 1, 2026	Covered