D80.4 coverage policies: Medicare and commercial payers

66 active Medicare policies list D80.4, 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 D80.4

LCD · CGS-J15-L34037

Flow Cytometry

J15 · Effective Oct 1, 2015

LCD · FIRST_COAST-L38227

Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)

J9 · Effective Dec 30, 2019

LCD · NOVITAS-JH-L38229

Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)

JH · Effective Dec 30, 2019

LCD · NOVITAS-JL-L38229

Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)

JL · Effective Dec 30, 2019

LCD · FIRST_COAST-L34007

Immune Globulin

J9 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35093

Immune Globulin

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35093

Immune Globulin

JL · Effective Oct 1, 2015

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

Commercial payer policies listing D80.4

1 policy from 1 payer

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

Ambetter

Ambetter policies listing D80.4, with the code’s status in each
Policy	Effective	Status of D80.4
Polymerase Chain Reaction Respiratory Viral Panel TestingPayerPolicy · AMBETTER-CP-MP-181	Not recorded	Covered