M50.33 coverage policies: Medicare and commercial payers

60 active Medicare policies list M50.33, 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 M50.33

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-L39741

Cervical Fusion

J15 · Effective Jul 7, 2024

LCD · FIRST_COAST-L39799

Cervical Fusion

J9 · Effective Aug 11, 2024

LCD · NGS-J6-L39770

Cervical Fusion

J6 · Effective Aug 1, 2024

LCD · NGS-JK-L39770

Cervical Fusion

JK · Effective Aug 1, 2024

LCD · NORIDIAN-JE-L39758

Cervical Fusion

JE · Effective Jul 7, 2024

Commercial payer policies listing M50.33

2 policies from 2 payers

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

Aetna

Aetna policies listing M50.33, with the code’s status in each
Policy	Effective	Status of M50.33
Open Air, Low Field Strength, and Positional Magnetic Resonance Imaging (MRI) UnitsPayerPolicy · AETNA-CPB-0093	Mar 21, 2023	Covered

Cigna

Cigna policies listing M50.33, with the code’s status in each
Policy	Effective	Status of M50.33
Intraoperative MonitoringPayerPolicy · CIGNA-0509	Sep 15, 2025	Covered