M17.5 coverage policies: Medicare and commercial payers

55 active Medicare policies list M17.5, 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.

Get free alerts for M17.5

Free account. Policy pages stay open to everyone.

Medicare policies listing M17.5

LCD · NORIDIAN-JE-L39116

Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

JE · Effective Nov 12, 2023

LCD · NORIDIAN-JF-L39116

Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

JF · Effective Nov 12, 2023

LCD · PALMETTO-JJ-L39128

Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

JJ · Effective Apr 30, 2023

LCD · PALMETTO-JM-L39128

Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

JM · Effective Apr 30, 2023

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 · NGS-J6-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

JK · Effective Oct 1, 2015

LCD · NGS-J6-L40333

Commercial payer policies listing M17.5

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 M17.5, with the code’s status in each
Policy	Effective	Status of M17.5
Acupuncture and Dry NeedlingPayerPolicy · AETNA-CPB-0135	Apr 5, 2023	Covered
Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell TransplantationPayerPolicy · AETNA-CPB-0599	Aug 30, 2023	Covered
ViscosupplementationPayerPolicy · AETNA-CPB-0179	Jan 1, 2024	Covered

UnitedHealthcare

UnitedHealthcare policies listing M17.5, with the code’s status in each
Policy	Effective	Status of M17.5
Sodium HyaluronatePayerPolicy · UHC-POL-sodium-hyaluronate	Oct 1, 2026	Covered