K76.89 coverage policies: Medicare and commercial payers

20 active Medicare policies list K76.89, and 4 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 K76.89

LCD · NOVITAS-JH-L35022

Bariatric Surgical Management of Morbid Obesity

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35022

Bariatric Surgical Management of Morbid Obesity

JL · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34415

CT of the Abdomen and Pelvis

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34415

CT of the Abdomen and Pelvis

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34576

Laparoscopic Sleeve Gastrectomy for Severe Obesity

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34576

Laparoscopic Sleeve Gastrectomy for Severe Obesity

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 · FIRST_COAST-L33411

Surgical Management of Morbid Obesity

J9 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34434

Upper Gastrointestinal Endoscopy and Visualization

Commercial payer policies listing K76.89

4 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 K76.89, with the code’s status in each
Policy	Effective	Status of K76.89
Heart TransplantationPayerPolicy · AETNA-CPB-0586	Aug 30, 2023	Covered
Pancreas Kidney TransplantationPayerPolicy · AETNA-CPB-0587	Aug 30, 2023	Covered
Verteporfin (Visudyne) Photodynamic TherapyPayerPolicy · AETNA-CPB-0594	Jun 29, 2023	Covered

Anthem

Anthem policies listing K76.89, with the code’s status in each
Policy	Effective	Status of K76.89
Outpatient Alpha-Fetoprotein TestingClinical Guideline · ANTHEM-CG-LAB-26	Apr 15, 2026	Covered

K76.89 coverage policies: Medicare and commercial payers

Medicare policies listing K76.89

Bariatric Surgical Management of Morbid Obesity

Bariatric Surgical Management of Morbid Obesity

CT of the Abdomen and Pelvis

CT of the Abdomen and Pelvis

Laparoscopic Sleeve Gastrectomy for Severe Obesity

Laparoscopic Sleeve Gastrectomy for Severe Obesity

Monitored Anesthesia Care

Monitored Anesthesia Care

Surgical Management of Morbid Obesity

Upper Gastrointestinal Endoscopy and Visualization

Commercial payer policies listing K76.89

Aetna

Anthem

K76.89 coverage policies: Medicare and commercial payers

Medicare policies listing K76.89

Bariatric Surgical Management of Morbid Obesity

Bariatric Surgical Management of Morbid Obesity

CT of the Abdomen and Pelvis

CT of the Abdomen and Pelvis

Laparoscopic Sleeve Gastrectomy for Severe Obesity

Laparoscopic Sleeve Gastrectomy for Severe Obesity

Monitored Anesthesia Care

Monitored Anesthesia Care

Surgical Management of Morbid Obesity

Upper Gastrointestinal Endoscopy and Visualization

Commercial payer policies listing K76.89

Aetna

Anthem

Upper Gastrointestinal Endoscopy and Visualization

Vitamin D Assay Testing

Vitamin D Assay Testing

Billing and Coding: Bariatric Surgical Management of Morbid Obesity

Billing and Coding: CT of the Abdomen and Pelvis

Billing and Coding: Laparoscopic Sleeve Gastrectomy for Severe Obesity

Billing and Coding: Monitored Anesthesia Care

Billing and Coding: Surgical Management of Morbid Obesity

Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

Billing and Coding: Vitamin D Assay Testing