R10.33 coverage policies: Medicare and commercial payers

70 active Medicare policies list R10.33, 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 R10.33

LCD · CGS-J15-L34005

Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34454

Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34454

Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33459

Computerized Axial Tomography (CT), Thorax

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33459

Computerized Axial Tomography (CT), Thorax

JM · Effective Oct 1, 2015

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 · NORIDIAN-JE-L34213

Diagnostic and Therapeutic Colonoscopy

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34213

Diagnostic and Therapeutic Colonoscopy

JF · Effective Oct 1, 2015

LCD · FIRST_COAST-L33583

Diagnostic and Therapeutic Esophagogastroduodenoscopy

Commercial payer policies listing R10.33

3 policies from 1 payer

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

Aetna

Aetna policies listing R10.33, with the code’s status in each
Policy	Effective	Status of R10.33
Athletic Pubalgia SurgeryPayerPolicy · AETNA-CPB-0750	Oct 6, 2023	Covered
Chronic Pelvic Pain, Endometriosis, and Other Indications: Selected TreatmentsPayerPolicy · AETNA-CPB-0754	Oct 5, 2023	Covered
Selected Kidney Function TestsPayerPolicy · AETNA-CPB-0775	Oct 11, 2023	Covered