M53.3 coverage policies: Medicare and commercial payers

66 active Medicare policies list M53.3, and 6 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 M53.3

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 · 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-L34218

Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma

Commercial payer policies listing M53.3

6 policies from 1 payer

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

Aetna

Aetna policies listing M53.3, with the code’s status in each
Policy	Effective	Status of M53.3
Back Pain - Invasive ProceduresPayerPolicy · AETNA-CPB-0016	Mar 13, 2024	Covered
Botulinum ToxinPayerPolicy · AETNA-CPB-0113	Jan 1, 2024	Covered
Continuous Passive Motion (CPM) MachinesPayerPolicy · AETNA-CPB-0010	Mar 15, 2024	Covered
Laser NeurolysisPayerPolicy · AETNA-CPB-0552	Jul 27, 2023	Covered
Prolotherapy and SclerotherapyPayerPolicy · AETNA-CPB-0207	Apr 11, 2023	Covered
Pulsed RadiofrequencyPayerPolicy · AETNA-CPB-0735	Sep 20, 2023	Covered