S05.52XS coverage policies: Medicare and commercial payers

24 active Medicare policies list S05.52XS, and 4 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 S05.52XS

LCD · PALMETTO-JJ-L33428

Cosmetic and Reconstructive Surgery

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33428

Cosmetic and Reconstructive Surgery

JM · Effective Oct 1, 2015

LCD · CGS-J15-L34032

Debridement Services

J15 · Effective Oct 1, 2015

LCD · FIRST_COAST-L37398

Electroretinography (ERG)

J9 · Effective Feb 2, 2018

LCD · NOVITAS-JH-L37371

Electroretinography (ERG)

JH · Effective Jan 25, 2018

LCD · NOVITAS-JL-L37371

Electroretinography (ERG)

JL · Effective Jan 25, 2018

LCD · NORIDIAN-JE-L37373

MRI and CT Scans of the Head and Neck

JE · Effective Oct 8, 2018

LCD · NORIDIAN-JF-L37373

MRI and CT Scans of the Head and Neck

JF · Effective Oct 8, 2018

LCD · PALMETTO-JJ-L33467

Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33467

Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

Commercial payer policies listing S05.52XS

4 policies from 1 payer

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

Ambetter

Ambetter policies listing S05.52XS, with the code’s status in each
Policy	Effective	Status of S05.52XS
Extended OphthalmoscopyPayerPolicy · AMBETTER-CP-VP-26	Not recorded	Covered
External Ocular PhotographyPayerPolicy · AMBETTER-CP-VP-43	Not recorded	Covered
Fundus PhotographyPayerPolicy · AMBETTER-CP-VP-29	Not recorded	Covered
GonioscopyPayerPolicy · AMBETTER-CP-VP-31	Not recorded	Covered