G56.42 coverage policies: Medicare and commercial payers

58 active Medicare policies list G56.42, 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 G56.42

LCD · PALMETTO-JJ-L37641

Continuous Peripheral Nerve Blocks (CPNB)

JJ · Effective Jan 29, 2018

LCD · PALMETTO-JM-L37641

Continuous Peripheral Nerve Blocks (CPNB)

JM · Effective Jan 29, 2018

LCD · PALMETTO-JJ-L33461

Implantable Infusion Pump

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33461

Implantable Infusion Pump

JM · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L37373

MRI and CT Scans of the Head and Neck

JE · Effective Oct 8, 2018

LCD · NORIDIAN-JF-L37373

MRI and CT Scans of the Head and Neck

JF · Effective Oct 8, 2018

LCD · NORIDIAN-JE-L35456

Nerve Blockade for Treatment of Chronic Pain and Neuropathy

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L35456

Nerve Blockade for Treatment of Chronic Pain and Neuropathy

JF · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L37642

Nerve Blocks and Electrostimulation for Peripheral Neuropathy

JJ · Effective Jan 29, 2018

LCD · PALMETTO-JM-L37642

Commercial payer policies listing G56.42

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 G56.42, with the code’s status in each
Policy	Effective	Status of G56.42
Laser NeurolysisPayerPolicy · AETNA-CPB-0552	Jul 27, 2023	Covered
Thoracoscopic SympathectomyPayerPolicy · AETNA-CPB-0310	May 8, 2023	Covered