M47.894 coverage policies: Medicare and commercial payers

52 active Medicare policies list M47.894, 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 M47.894

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 · CGS-J15-L38773

Facet Joint Interventions for Pain Management

J15 · Effective May 2, 2021

LCD · FIRST_COAST-L33930

Facet Joint Interventions for Pain Management

J9 · Effective Oct 1, 2015

LCD · FIRST_COAST-L40404

Facet Joint Interventions for Pain Management

LCD · NGS-J6-L35936

Facet Joint Interventions for Pain Management

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L35936

Facet Joint Interventions for Pain Management

Commercial payer policies listing M47.894

1 policy from 1 payer

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

UnitedHealthcare

UnitedHealthcare policies listing M47.894, with the code’s status in each
Policy	Effective	Status of M47.894
Facet Joint and Medial Branch Block Injections for Spinal PainPayerPolicy · UHC-POL-facet-joint-injections-spinal-pain	Sep 10, 2026	Covered