M75.02 coverage policies: Medicare and commercial payers

34 active Medicare policies list M75.02, and 5 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 M75.02

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 · NORIDIAN-JE-L34218

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

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34218

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

JF · Effective Oct 1, 2015

LCD · NGS-J6-L40268

Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts

LCD · NGS-JK-L40268

Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts

LCD · NGS-J6-L33622

Commercial payer policies listing M75.02

5 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 M75.02, with the code’s status in each
Policy	Effective	Status of M75.02
Electrothermal ArthroscopyPayerPolicy · AETNA-CPB-0545	Aug 4, 2023	Covered
Manipulation Under General AnesthesiaPayerPolicy · AETNA-CPB-0204	Mar 29, 2023	Covered
PhonophoresisPayerPolicy · AETNA-CPB-0210	Apr 11, 2023	Covered
Pulsed RadiofrequencyPayerPolicy · AETNA-CPB-0735	Sep 20, 2023	Covered

UnitedHealthcare

UnitedHealthcare policies listing M75.02, with the code’s status in each
Policy	Effective	Status of M75.02
Manipulation Under AnesthesiaPayerPolicy · UHC-POL-manipulation-under-anesthesia