K90.41 coverage policies: Medicare and commercial payers

33 active Medicare policies list K90.41, and 1 commercial payer policy lists 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 K90.41

LCD · CGS-J15-L34005

Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15 · 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 · FIRST_COAST-L33583

Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9 · Effective Oct 1, 2015

LCD · CGS-J15-L34081

Endoscopy by Capsule

J15 · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L36702

Serum Magnesium

JE · Effective Mar 13, 2017

LCD · NORIDIAN-JF-L36702

Serum Magnesium

JF · Effective Mar 13, 2017

LCD · PALMETTO-JJ-L34434

Upper Gastrointestinal Endoscopy and Visualization

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34434

Upper Gastrointestinal Endoscopy and Visualization

JM · Effective Oct 1, 2015

LCD · FIRST_COAST-L33967

Vitamin B<sub>12</sub> Injections

Commercial payer policies listing K90.41

1 policy from 1 payer

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

Anthem

Anthem policies listing K90.41, with the code’s status in each
Policy	Effective	Status of K90.41
Selected Blood, Serum and Cellular Allergy and Toxicity TestsPayerPolicy · ANTHEM-LAB.00027	Jul 1, 2026	Not covered