M79.641 coverage policies: Medicare and commercial payers

73 active Medicare policies list M79.641, 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 M79.641

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 · FIRST_COAST-L33674

Duplex Scanning

J9 · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34315

Electrocardiograms

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34315

Electrocardiograms

JF · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L37642

Nerve Blocks and Electrostimulation for Peripheral Neuropathy

JJ · Effective Jan 29, 2018

LCD · PALMETTO-JM-L37642

Nerve Blocks and Electrostimulation for Peripheral Neuropathy

Commercial payer policies listing M79.641

2 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 M79.641, with the code’s status in each
Policy	Effective	Status of M79.641
Serum Iron TestingClinical Guideline · ANTHEM-CG-LAB-21	Apr 15, 2026	Covered

EviCore by Evernorth

EviCore by Evernorth policies listing M79.641, with the code’s status in each
Policy	Effective	Status of M79.641
Massage TherapyEffective 06/04/2018 - 02/14/2019PayerPolicy · EVICORE-MSK_THERAPIES-368D1D72660A	Jun 4, 2018	Covered