N80.A42 coverage policies: Medicare and commercial payers

12 active Medicare policies list N80.A42, 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 N80.A42

LCD · PALMETTO-JJ-L34415

CT of the Abdomen and Pelvis

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34415

CT of the Abdomen and Pelvis

JM · Effective Oct 1, 2015

LCD · NGS-J6-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

JK · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L39387

Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

JJ · Effective Feb 19, 2023

LCD · PALMETTO-JM-L39387

Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

JM · Effective Feb 19, 2023

LCD · PALMETTO-JJ-L34577

Retroperitoneal Ultrasound

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34577

Retroperitoneal Ultrasound

JM · Effective Oct 1, 2015

Article · A56421

Billing and Coding: CT of the Abdomen and Pelvis

National · Effective Nov 1, 2025

Article · A52453

Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

Commercial payer policies listing N80.A42

1 policy from 1 payer

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

Regence BCBS

Regence BCBS policies listing N80.A42, with the code’s status in each
Policy	Effective	Status of N80.A42
HysterectomyPayerPolicy · REGENCE-SUR218	Jul 1, 2026	Covered