M80.00XA coverage policies: Medicare and commercial payers

25 active Medicare policies list M80.00XA, 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.

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Medicare policies listing M80.00XA

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 · CGS-J15-L33996

Vitamin D Assay Testing

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L39391

Vitamin D Assay Testing

JJ · Effective Jan 29, 2023

LCD · PALMETTO-JM-L39391

Vitamin D Assay Testing

Commercial payer policies listing M80.00XA

1 policy from 1 payer

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

Anthem

Anthem policies listing M80.00XA, with the code’s status in each
Policy	Effective	Status of M80.00XA
Vitamin D TestingClinical Guideline · ANTHEM-CG-LAB-11	Oct 1, 2026	Covered