M25.751 coverage policies: Medicare and commercial payers

25 active Medicare policies list M25.751, and 1 commercial payer policy lists 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 M25.751

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 · NGS-J6-L33619

Nonvascular Extremity Ultrasound

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33619

Nonvascular Extremity Ultrasound

JK · Effective Oct 1, 2015

LCD · NGS-J6-L40268

Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts

LCD · NGS-JK-L40268

Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts

LCD · NGS-J6-L33622

Pain Management - Injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels

Commercial payer policies listing M25.751

1 policy from 1 payer

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

Aetna

Aetna policies listing M25.751, with the code’s status in each
Policy	Effective	Status of M25.751
Back Pain - Invasive ProceduresPayerPolicy · AETNA-CPB-0016	Mar 13, 2024	Covered