D33.3 coverage policies: Medicare and commercial payers

114 active Medicare policies list D33.3, and 12 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.

Get free alerts for D33.3

Free account. Policy pages stay open to everyone.

Medicare policies listing D33.3

Showing 100 of 114

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

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-L34417

CT of the Head

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34417

CT of the Head

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 · NOVITAS-JH-L35003

Intraoperative Neurophysiological Testing

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35003

Intraoperative Neurophysiological Testing

Commercial payer policies listing D33.3

12 policies from 3 payers

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

Aetna

Aetna policies listing D33.3, with the code’s status in each
Policy	Effective	Status of D33.3
Chronic VertigoPayerPolicy · AETNA-CPB-0238	Apr 26, 2023	Covered
Cochlear Implants and Auditory Brainstem ImplantsPayerPolicy · AETNA-CPB-0013	Feb 8, 2024	Covered
CryoablationPayerPolicy · AETNA-CPB-0100	Dec 5, 2023	Covered
Intraoperative Neurophysiological MonitoringPayerPolicy · AETNA-CPB-0697	Oct 26, 2023	Covered
Myringotomy and Tympanostomy TubePayerPolicy · AETNA-CPB-0418	Jun 7, 2023	Covered
Optic Nerve Decompression SurgeryPayerPolicy · AETNA-CPB-0415	Jun 27, 2023	Covered

Policy	Effective	Status of D33.3
Extended OphthalmoscopyPayerPolicy · AMBETTER-CP-VP-26	Not recorded	Covered
Fundus PhotographyPayerPolicy · AMBETTER-CP-VP-29	Not recorded	Covered
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered

Policy	Effective	Status of D33.3
Auditory Brainstem Responses (ABRs) and Evoked Otoacoustic Emissions (OAEs) for Hearing DisordersClinical Guideline · ANTHEM-CG-MED-49	Jul 1, 2026	Covered
Cochlear Implants and Auditory Brainstem ImplantsClinical Guideline · ANTHEM-CG-SURG-81	Jul 1, 2026	Covered
Fundus PhotographyClinical Guideline · ANTHEM-CG-MED-47	Apr 15, 2026	Covered