H40.53X4 coverage policies: Medicare and commercial payers

62 active Medicare policies list H40.53X4, 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 H40.53X4

LCD · FIRST_COAST-L38926

Cataract Extraction (including Complex Cataract Surgery)

J9 · Effective Jul 11, 2021

LCD · NOVITAS-JH-L35091

Cataract Extraction (including Complex Cataract Surgery)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35091

Cataract Extraction (including Complex Cataract Surgery)

JL · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34413

Cataract Surgery

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34413

Cataract Surgery

JM · Effective Oct 1, 2015

LCD · WPS-J5-L37205

Chemotherapy Drugs and their Adjuncts

J5 · Effective Sep 16, 2017

LCD · WPS-J8-L37205

Chemotherapy Drugs and their Adjuncts

J8 · Effective Sep 16, 2017

LCD · CGS-J15-L33999

Corneal Pachymetry

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L33630

Corneal Pachymetry

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33630

Corneal Pachymetry

JK · Effective Oct 1, 2015

Commercial payer policies listing H40.53X4

2 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 H40.53X4, with the code’s status in each
Policy	Effective	Status of H40.53X4
Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)Clinical Guideline · ANTHEM-CG-SURG-118	Apr 15, 2026	Covered
Laser Trabeculoplasty and Laser Peripheral IridotomyClinical Guideline · ANTHEM-CG-SURG-100	Oct 1, 2026	Covered