E09.21 coverage policies: Medicare and commercial payers

49 active Medicare policies list E09.21, and 3 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 E09.21

LCD · WPS-J5-L35490

Category III Codes

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L35490

Category III Codes

J8 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33431

HbA1c

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33431

HbA1c

JM · Effective Oct 1, 2015

LCD · CGS-J15-L38662

Implantable Continuous Glucose Monitors (I-CGM)

J15 · Effective Nov 2, 2020

LCD · FIRST_COAST-L38664

Implantable Continuous Glucose Monitors (I-CGM)

J9 · Effective Oct 11, 2020

LCD · NGS-J6-L38623

Implantable Continuous Glucose Monitors (I-CGM)

J6 · Effective Dec 1, 2020

LCD · NGS-JK-L38623

Implantable Continuous Glucose Monitors (I-CGM)

JK · Effective Dec 1, 2020

LCD · NORIDIAN-JE-L38657

Implantable Continuous Glucose Monitors (I-CGM)

JE · Effective Nov 2, 2020

LCD · NORIDIAN-JF-L38657

Implantable Continuous Glucose Monitors (I-CGM)

JF · Effective Nov 2, 2020

Commercial payer policies listing E09.21

3 policies from 1 payer

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

Anthem

Anthem policies listing E09.21, with the code’s status in each
Policy	Effective	Status of E09.21
Outpatient Urine CultureClinical Guideline · ANTHEM-CG-LAB-24	Jan 6, 2026	Covered
Pancreas Transplantation and Pancreas Kidney TransplantationPayerPolicy · ANTHEM-TRANS.00011	Oct 1, 2026	Covered
Vitamin D TestingClinical Guideline · ANTHEM-CG-LAB-11	Oct 1, 2026	Covered