M25.59 coverage policies: Medicare and commercial payers

49 active Medicare policies list M25.59, 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.

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Medicare policies listing M25.59

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-L37641

Continuous Peripheral Nerve Blocks (CPNB)

JJ · Effective Jan 29, 2018

LCD · PALMETTO-JM-L37641

Continuous Peripheral Nerve Blocks (CPNB)

JM · Effective Jan 29, 2018

LCD · FIRST_COAST-L36393

Controlled Substance Monitoring and Drugs of Abuse Testing

J9 · Effective Oct 11, 2015

LCD · NOVITAS-JH-L35006

Controlled Substance Monitoring and Drugs of Abuse Testing

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35006

Commercial payer policies listing M25.59

4 policies from 2 payers

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

Anthem

Anthem policies listing M25.59, with the code’s status in each
Policy	Effective	Status of M25.59
Serum Iron TestingClinical Guideline · ANTHEM-CG-LAB-21	Apr 15, 2026	Covered
Therapeutic use of Stem Cells, Blood and Bone Marrow ProductsPayerPolicy · ANTHEM-TRANS.00035	Oct 1, 2026	Not covered
Trigger Point InjectionsClinical Guideline · ANTHEM-CG-SURG-17	Jul 1, 2026	Covered

Aetna

Aetna policies listing M25.59, with the code’s status in each
Policy	Effective	Status of M25.59
Prolotherapy and SclerotherapyPayerPolicy · AETNA-CPB-0207	Apr 11, 2023	Covered