M54.11 coverage policies: Medicare and commercial payers

76 active Medicare policies list M54.11, 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 M54.11

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 M54.11

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 M54.11, with the code’s status in each
Policy	Effective	Status of M54.11
Back Pain - Invasive ProceduresPayerPolicy · AETNA-CPB-0016	Mar 13, 2024	Covered

Cigna

Cigna policies listing M54.11, with the code’s status in each
Policy	Effective	Status of M54.11
Intraoperative MonitoringPayerPolicy · CIGNA-0509	Sep 15, 2025	Covered