D42.0 coverage policies: Medicare and commercial payers

81 active Medicare policies list D42.0, 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 D42.0

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 · NGS-J6-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

JK · Effective Oct 1, 2015

LCD · NGS-J6-L40333

Erythropoiesis Stimulating Agents

LCD · NGS-J6-L40334

Erythropoiesis Stimulating Agents

J6 · Effective Jul 15, 2026

LCD · NGS-JK-L40333

Erythropoiesis Stimulating Agents

Commercial payer policies listing D42.0

2 policies from 1 payer

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

Aetna

Aetna policies listing D42.0, with the code’s status in each
Policy	Effective	Status of D42.0
Back Pain - Invasive ProceduresPayerPolicy · AETNA-CPB-0016	Mar 13, 2024	Covered
Intraoperative Neurophysiological MonitoringPayerPolicy · AETNA-CPB-0697	Oct 26, 2023	Covered