M53.86 coverage policies: Medicare and commercial payers

41 active Medicare policies list M53.86, 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.

Get free alerts for M53.86

Free account. Policy pages stay open to everyone.

Medicare policies listing M53.86

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 · NGS-J6-L35936

Facet Joint Interventions for Pain Management

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L35936

Facet Joint Interventions for Pain Management

JK · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L38801

Facet Joint Interventions for Pain Management

JE · Effective Apr 25, 2021

LCD · NORIDIAN-JF-L38801

Facet Joint Interventions for Pain Management

Commercial payer policies listing M53.86

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 M53.86, with the code’s status in each
Policy	Effective	Status of M53.86
Blood and Adipose Tissue Derived Products for Selected IndicationsPayerPolicy · AETNA-CPB-0784	Oct 26, 2023	Covered