M19.09 coverage policies: Medicare and commercial payers

30 active Medicare policies list M19.09, 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 M19.09

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 · 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 · PALMETTO-JJ-L35048

Nerve Conduction Studies and Electromyography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L35048

Nerve Conduction Studies and Electromyography

JM · Effective Oct 1, 2015

LCD · NGS-J6-L39995

Commercial payer policies listing M19.09

2 policies from 1 payer

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

Anthem

Anthem policies listing M19.09, with the code’s status in each
Policy	Effective	Status of M19.09
IontophoresisClinical Guideline · ANTHEM-CG-MED-28	Jan 6, 2026	Covered
Temporomandibular DisordersClinical Guideline · ANTHEM-CG-SURG-09	Oct 1, 2026	Covered