K92.1 coverage policies: Medicare and commercial payers

76 active Medicare policies list K92.1, 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 K92.1

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

LCD · WPS-J5-L35490

Category III Codes

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L35490

Category III Codes

J8 · Effective Oct 1, 2015

LCD · CGS-J15-L38777

Colon Capsule Endoscopy (CCE)

J15 · Effective Mar 29, 2021

LCD · FIRST_COAST-L38805

Colon Capsule Endoscopy (CCE)

J9 · Effective Mar 28, 2021

LCD · NGS-J6-L38571

Colon Capsule Endoscopy (CCE)

J6 · Effective Apr 15, 2021

LCD · NGS-J6-L39122

Colon Capsule Endoscopy (CCE)

LCD · NGS-JK-L38571

Colon Capsule Endoscopy (CCE)

JK · Effective Apr 15, 2021

LCD · NGS-JK-L39122

Colon Capsule Endoscopy (CCE)

LCD · NORIDIAN-JE-L38824

Colon Capsule Endoscopy (CCE)

JE · Effective Mar 28, 2021

LCD · NORIDIAN-JF-L38824

Commercial payer policies listing K92.1

2 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 K92.1, with the code’s status in each
Policy	Effective	Status of K92.1
Transjugular Intrahepatic Portosystemic Shunt (TIPSS)PayerPolicy · AETNA-CPB-0259	May 5, 2023	Covered

Anthem

Anthem policies listing K92.1, with the code’s status in each
Policy	Effective	Status of K92.1
Wireless Capsule Endoscopy for Gastrointestinal Imaging and the Patency CapsuleClinical Guideline · ANTHEM-CG-MED-70	Oct 1, 2026	Covered