H05.021 coverage policies: Medicare and commercial payers

24 active Medicare policies list H05.021, 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 H05.021

LCD · PALMETTO-JJ-L33428

Cosmetic and Reconstructive Surgery

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33428

Cosmetic and Reconstructive Surgery

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34425

Magnetic Resonance Imaging of the Head and Neck

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34425

Magnetic Resonance Imaging of the Head and Neck

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 · CGS-J15-L34393

Ocular Photography - External

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L34380

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L34380

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

JK · Effective Oct 1, 2015

LCD · FIRST_COAST-L33766

Visual Field Examination

Commercial payer policies listing H05.021

2 policies from 1 payer

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

Ambetter

Ambetter policies listing H05.021, with the code’s status in each
Policy	Effective	Status of H05.021
External Ocular PhotographyPayerPolicy · AMBETTER-CP-VP-43	Not recorded	Covered
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered