L20.84 coverage policies: Medicare and commercial payers

41 active Medicare policies list L20.84, 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 L20.84

LCD · CGS-J15-L40056

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J15 · Effective Oct 26, 2025

LCD · NGS-J6-L40048

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J6 · Effective Oct 26, 2025

LCD · NGS-JK-L40048

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

JK · Effective Oct 26, 2025

LCD · NORIDIAN-JE-L40050

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

JE · Effective Oct 26, 2025

LCD · NORIDIAN-JF-L40050

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

JF · Effective Oct 26, 2025

LCD · PALMETTO-JJ-L40046

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

JJ · Effective Oct 26, 2025

LCD · PALMETTO-JM-L40046

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

JM · Effective Oct 26, 2025

LCD · WPS-J5-L36408

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J5 · Effective Mar 18, 2016

LCD · WPS-J8-L36408

Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J8 · Effective Mar 18, 2016

Commercial payer policies listing L20.84

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 L20.84, with the code’s status in each
Policy	Effective	Status of L20.84
Allergy TestingPayerPolicy · AMBETTER-CP-MP-100	Not recorded	Covered
Laser Therapy for Skin ConditionsPayerPolicy · AMBETTER-CP-MP-123	Not recorded	Covered