Z85.3 coverage policies: Medicare and commercial payers

94 active Medicare policies list Z85.3, and 11 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 Z85.3

LCD · WPS-J5-L34648

Bisphosphonate Drug Therapy

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L34648

Bisphosphonate Drug Therapy

J8 · Effective Oct 1, 2015

LCD · FIRST_COAST-L36499

BRCA1 and BRCA2 Genetic Testing

J9 · Effective Apr 11, 2016

LCD · NOVITAS-JH-L36715

BRCA1 and BRCA2 Genetic Testing

JH · Effective Dec 1, 2016

LCD · NOVITAS-JL-L36715

BRCA1 and BRCA2 Genetic Testing

JL · Effective Dec 1, 2016

LCD · CGS-J15-L33950

Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L33585

Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33585

Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography

JK · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33457

Cardiac Radionuclide Imaging

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33457

Cardiac Radionuclide Imaging

Commercial payer policies listing Z85.3

11 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 Z85.3, with the code’s status in each
Policy	Effective	Status of Z85.3
Breast Ductal Lavage and Fiberoptic DuctoscopyPayerPolicy · AETNA-CPB-0517	Jul 12, 2023	Covered
Breast Reconstructive SurgeryPayerPolicy · AETNA-CPB-0185	Apr 7, 2023	Covered
Cosmetic Surgery and ProceduresPayerPolicy · AETNA-CPB-0031	Feb 8, 2024	Covered
External Breast ProsthesisPayerPolicy · AETNA-CPB-0097	Dec 15, 2023	Covered
Fibroid TreatmentPayerPolicy · AETNA-CPB-0304	Feb 15, 2024	Covered
Skin and Soft Tissue SubstitutesPayerPolicy · AETNA-CPB-0244	Feb 9, 2024	Covered

Policy	Effective	Status of Z85.3
Breast Procedures; including Reconstructive Surgery, Implants and Other Breast ProceduresPayerPolicy · ANTHEM-SURG.00023	Jul 1, 2026	Covered
Carcinoembryonic Antigen TestingClinical Guideline · ANTHEM-CG-LAB-33	Oct 1, 2026	Covered
Cosmetic and Reconstructive Services of the Trunk, Groin, and ExtremitiesPayerPolicy · ANTHEM-ANC.00009	Oct 1, 2026	Covered
Cosmetic and Reconstructive Services: Skin RelatedPayerPolicy · ANTHEM-ANC.00007	Jan 6, 2026	Covered