M79.12 coverage policies: Medicare and commercial payers

82 active Medicare policies list M79.12, 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 M79.12

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 · NOVITAS-JH-L34914

Assays for Vitamins and Metabolic Function

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34914

Assays for Vitamins and Metabolic Function

JL · Effective Oct 1, 2015

LCD · FIRST_COAST-L36393

Controlled Substance Monitoring and Drugs of Abuse Testing

J9 · Effective Oct 11, 2015

LCD · NOVITAS-JH-L35006

Controlled Substance Monitoring and Drugs of Abuse Testing

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35006

Commercial payer policies listing M79.12

3 policies from 2 payers

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

Anthem

Anthem policies listing M79.12, with the code’s status in each
Policy	Effective	Status of M79.12
IontophoresisClinical Guideline · ANTHEM-CG-MED-28	Jan 6, 2026	Covered
Temporomandibular DisordersClinical Guideline · ANTHEM-CG-SURG-09	Oct 1, 2026	Covered

Ambetter

Ambetter policies listing M79.12, with the code’s status in each
Policy	Effective	Status of M79.12
Trigger Point Injections for Pain ManagementPayerPolicy · AMBETTER-CP-MP-169	Not recorded	Covered