M97.01XA coverage policies: Medicare and commercial payers

27 active Medicare policies list M97.01XA, 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 M97.01XA

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-L36007

Lower Extremity Major Joint Replacement (Hip and Knee)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L36007

Lower Extremity Major Joint Replacement (Hip and Knee)

JL · Effective Oct 1, 2015

LCD · FIRST_COAST-L33618

Major Joint Replacement (Hip and Knee)

J9 · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34163

Total Hip Arthroplasty

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34163

Total Hip Arthroplasty

Commercial payer policies listing M97.01XA

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 M97.01XA, with the code’s status in each
Policy	Effective	Status of M97.01XA
Serum Iron TestingClinical Guideline · ANTHEM-CG-LAB-21	Apr 15, 2026	Covered