D69.49 coverage policies: Medicare and commercial payers

58 active Medicare policies list D69.49, 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 D69.49

LCD · NOVITAS-JH-L34914

Assays for Vitamins and Metabolic Function

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34914

Assays for Vitamins and Metabolic Function

JL · Effective Oct 1, 2015

LCD · WPS-J5-L37205

Chemotherapy Drugs and their Adjuncts

J5 · Effective Sep 16, 2017

LCD · WPS-J8-L37205

Chemotherapy Drugs and their Adjuncts

J8 · Effective Sep 16, 2017

LCD · CGS-J15-L34037

Flow Cytometry

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L37606

Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

J6 · Effective Aug 1, 2018

LCD · NGS-JK-L37606

Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

JK · Effective Aug 1, 2018

LCD · NORIDIAN-JE-L34314

Immune Globulin Intravenous (IVIg)

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34314

Immune Globulin Intravenous (IVIg)

JF · Effective Oct 1, 2015

LCD · WPS-J5-L34771

Immune Globulins

Commercial payer policies listing D69.49

2 policies from 1 payer

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

Cigna

Cigna policies listing D69.49, with the code’s status in each
Policy	Effective	Status of D69.49
Flow CytometryPayerPolicy · CIGNA-0538	Sep 15, 2026	Covered
Serum Folate and Red Blood Cell Folate TestingPayerPolicy · CIGNA-0567	Dec 15, 2025	Covered