M48.04 coverage policies: Medicare and commercial payers

57 active Medicare policies list M48.04, 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 M48.04

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-L33461

Implantable Infusion Pump

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33461

Implantable Infusion Pump

JM · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L35456

Nerve Blockade for Treatment of Chronic Pain and Neuropathy

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L35456

Nerve Blockade for Treatment of Chronic Pain and Neuropathy

JF · Effective Oct 1, 2015

LCD · CGS-J15-L35897

Nerve Conduction Studies and Electromyography

Commercial payer policies listing M48.04

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 M48.04, with the code’s status in each
Policy	Effective	Status of M48.04
Continuous Passive Motion (CPM) MachinesPayerPolicy · AETNA-CPB-0010	Mar 15, 2024	Covered