D31.12 coverage policies: Medicare and commercial payers

37 active Medicare policies list D31.12, and 4 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 D31.12

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 · CGS-J15-L34037

Flow Cytometry

J15 · 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 · PALMETTO-JJ-L34425

Magnetic Resonance Imaging of the Head and Neck

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34425

Magnetic Resonance Imaging of the Head and Neck

JM · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L37373

MRI and CT Scans of the Head and Neck

JE · Effective Oct 8, 2018

LCD · NORIDIAN-JF-L37373

MRI and CT Scans of the Head and Neck

JF · Effective Oct 8, 2018

LCD · CGS-J15-L34393

Ocular Photography - External

Commercial payer policies listing D31.12

4 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 D31.12, with the code’s status in each
Policy	Effective	Status of D31.12
Anterior Segment Scanning Computerized Ophthalmic Diagnostic ImagingPayerPolicy · AETNA-CPB-0749	Oct 6, 2023	Covered
Corneal Graft and Amniotic Membrane Transplantation, Corneal Stromal Lenticule Transplantation, Limbal Stem Cell Transplantation, or Sural Nerve Grafting for Ocular IndicationsPayerPolicy · AETNA-CPB-0293	May 5, 2023	Covered

Ambetter

Ambetter policies listing D31.12, with the code’s status in each
Policy	Effective	Status of D31.12
External Ocular PhotographyPayerPolicy · AMBETTER-CP-VP-43	Not recorded	Covered
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered