Z85.43 coverage policies: Medicare and commercial payers

52 active Medicare policies list Z85.43, and 6 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 Z85.43

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 · PALMETTO-JJ-L33457

Cardiac Radionuclide Imaging

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33457

Cardiac Radionuclide Imaging

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 · NGS-J6-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

JK · Effective Oct 1, 2015

LCD · FIRST_COAST-L34912

Genetic Testing for Lynch Syndrome

Commercial payer policies listing Z85.43

6 policies from 2 payers

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

Anthem

Anthem policies listing Z85.43, with the code’s status in each
Policy	Effective	Status of Z85.43
Cancer Antigen 19-9 TestingClinical Guideline · ANTHEM-CG-LAB-35	Oct 1, 2026	Covered
Carcinoembryonic Antigen TestingClinical Guideline · ANTHEM-CG-LAB-33	Oct 1, 2026	Covered
Human Chorionic Gonadotropin TestingClinical Guideline · ANTHEM-CG-LAB-27	Apr 15, 2026	Covered
Outpatient Alpha-Fetoprotein TestingClinical Guideline · ANTHEM-CG-LAB-26	Apr 15, 2026	Covered

Aetna

Aetna policies listing Z85.43, with the code’s status in each
Policy	Effective	Status of Z85.43
Implantable Hormone PelletsPayerPolicy · AETNA-CPB-0345