T81.40XS coverage policies: Medicare and commercial payers

27 active Medicare policies list T81.40XS, 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 T81.40XS

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 · PALMETTO-JJ-L34417

CT of the Head

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34417

CT of the Head

JM · Effective Oct 1, 2015

LCD · CGS-J15-L34032

Debridement Services

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L37379

Echocardiography

JJ · Effective Sep 18, 2017

LCD · PALMETTO-JM-L37379

Echocardiography

JM · Effective Sep 18, 2017

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-L34577

Retroperitoneal Ultrasound

JJ · Effective Oct 1, 2015

Commercial payer policies listing T81.40XS

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 T81.40XS, with the code’s status in each
Policy	Effective	Status of T81.40XS
Breast Procedures; including Reconstructive Surgery, Implants and Other Breast ProceduresPayerPolicy · ANTHEM-SURG.00023	Jul 1, 2026	Covered