M53.83 coverage policies: Medicare and commercial payers

46 active Medicare policies list M53.83, and 3 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 M53.83

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 · CGS-J15-L38773

Facet Joint Interventions for Pain Management

J15 · Effective May 2, 2021

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 M53.83

3 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 M53.83, with the code’s status in each
Policy	Effective	Status of M53.83
Back Pain - Invasive ProceduresPayerPolicy · AETNA-CPB-0016	Mar 13, 2024	Covered
Laser NeurolysisPayerPolicy · AETNA-CPB-0552	Jul 27, 2023	Covered

Cigna

Cigna policies listing M53.83, with the code’s status in each
Policy	Effective	Status of M53.83
Intraoperative MonitoringPayerPolicy · CIGNA-0509	Sep 15, 2025	Covered