T86.5 coverage policies: Medicare and commercial payers

51 active Medicare policies list T86.5, 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 T86.5

LCD · NOVITAS-JH-L34914

Assays for Vitamins and Metabolic Function

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34914

Assays for Vitamins and Metabolic Function

JL · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34324

Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34324

Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

JF · Effective Oct 1, 2015

LCD · WPS-J5-L37205

Chemotherapy Drugs and their Adjuncts

J5 · Effective Sep 16, 2017

LCD · WPS-J8-L37205

Chemotherapy Drugs and their Adjuncts

J8 · Effective Sep 16, 2017

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 · CGS-J15-L34037

Flow Cytometry

J15 · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34314

Commercial payer policies listing T86.5

4 policies from 3 payers

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

Aetna

Aetna policies listing T86.5, with the code’s status in each
Policy	Effective	Status of T86.5
Donor Lymphocyte InfusionPayerPolicy · AETNA-CPB-0638	Sep 13, 2023	Covered
Romiplostim (Nplate)PayerPolicy · AETNA-CPB-0768	Jan 9, 2024	Covered

Anthem

Anthem policies listing T86.5, with the code’s status in each
Policy	Effective	Status of T86.5
Therapeutic ApheresisClinical Guideline · ANTHEM-CG-MED-68	Apr 15, 2026	Covered

Cigna

Cigna policies listing T86.5, with the code’s status in each
Policy	Effective	Status of T86.5
Flow CytometryPayerPolicy · CIGNA-0538