D21.22 coverage policies: Medicare and commercial payers

33 active Medicare policies list D21.22, 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 D21.22

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-L33461

Implantable Infusion Pump

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33461

Implantable Infusion Pump

JM · Effective Oct 1, 2015

LCD · NOVITAS-JH-L36007

Lower Extremity Major Joint Replacement (Hip and Knee)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L36007

Lower Extremity Major Joint Replacement (Hip and Knee)

JL · Effective Oct 1, 2015

LCD · FIRST_COAST-L33618

Major Joint Replacement (Hip and Knee)

J9 · Effective Oct 1, 2015

LCD · NGS-J6-L33619

Nonvascular Extremity Ultrasound

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33619

Nonvascular Extremity Ultrasound

JK · Effective Oct 1, 2015

LCD · FIRST_COAST-L33933

Peripheral Nerve Blocks

Commercial payer policies listing D21.22

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 D21.22, with the code’s status in each
Policy	Effective	Status of D21.22
Magnetic Resonance Imaging (MRI) of the ExtremitiesPayerPolicy · AETNA-CPB-0171	Apr 6, 2023	Covered