F10.121 coverage policies: Medicare and commercial payers

40 active Medicare policies list F10.121, 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 F10.121

LCD · NOVITAS-JH-L35006

Controlled Substance Monitoring and Drugs of Abuse Testing

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35006

Controlled Substance Monitoring and Drugs of Abuse Testing

JL · 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 · NOVITAS-JH-L35049

Monitored Anesthesia Care

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35049

Monitored Anesthesia Care

JL · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L39849

Opioid Treatment Programs

JJ · Effective Oct 20, 2024

LCD · PALMETTO-JM-L39849

Opioid Treatment Programs

JM · Effective Oct 20, 2024

LCD · CGS-J15-L34353

Outpatient Psychiatry and Psychology Services

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L39853

Outpatient Psychotherapy

JJ · Effective Oct 20, 2024

Commercial payer policies listing F10.121

2 policies from 2 payers

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

Aetna

Aetna policies listing F10.121, with the code’s status in each
Policy	Effective	Status of F10.121
Quantitative EEG (Brain Mapping)PayerPolicy · AETNA-CPB-0221	Apr 25, 2023	Covered

Cigna

Cigna policies listing F10.121, with the code’s status in each
Policy	Effective	Status of F10.121
Serum Folate and Red Blood Cell Folate TestingPayerPolicy · CIGNA-0567	Dec 15, 2025	Covered