Ambetter · PayerPolicy · AMBETTER-CP-MP-181
Summary of the payer’s published policy. Not a coverage determination — confirm with Ambetter before submitting.
Free account. Policy pages stay open to everyone.
Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
| Code | Code system | Status in this policy |
|---|---|---|
| 0098U | CPT | Covered |
| 0099U | CPT | Covered |
| 0100U | CPT | Covered |
| 0115U | CPT | Covered |
| 0202U | CPT | Covered |
| 0223U | CPT | Covered |
| 0225U | CPT | Covered |
| 87631 | CPT | Covered |
| 87632 | CPT | Covered |
| 87633 | CPT | Covered |
| 19 | HCPCS | Covered |
| 21 | HCPCS | Covered |
| 22* | HCPCS | Covered |
| 23 | HCPCS | Covered |
| A37.00 | ICD10CM | Covered |
| A37.01 | ICD10CM | Covered |
| A37.10 | ICD10CM | Covered |
| A37.11 | ICD10CM | Covered |
| A37.80 | ICD10CM | Covered |
| A37.81 | ICD10CM | Covered |
| A37.90 | ICD10CM | Covered |
| A37.91 | ICD10CM | Covered |
| A41.81 | ICD10CM | Covered |
| A41.89 | ICD10CM | Covered |
| A41.9 | ICD10CM | Covered |
| A48.1 | ICD10CM | Covered |
| A48.2 | ICD10CM | Covered |
| B20 | ICD10CM | Covered |
| B25.0 | ICD10CM | Covered |
| B33.23 | ICD10CM | Covered |
| B33.24 | ICD10CM | Covered |
| B59 | ICD10CM | Covered |
| B97.21 | ICD10CM | Covered |
| B97.29 | ICD10CM | Covered |
| C46.0 | ICD10CM | Covered |
| C46.1 | ICD10CM | Covered |
| C46.2 | ICD10CM | Covered |
| C46.3 | ICD10CM | Covered |
| C46.4 | ICD10CM | Covered |
| C46.50 | ICD10CM | Covered |
| C46.51 | ICD10CM | Covered |
| C46.52 | ICD10CM | Covered |
| C46.7 | ICD10CM | Covered |
| D57.01 | ICD10CM | Covered |
| D61.09 | ICD10CM | Covered |
| D61.1 | ICD10CM | Covered |
| D61.2 | ICD10CM | Covered |
| D61.3 | ICD10CM | Covered |
| D61.810 | ICD10CM | Covered |
| D61.811 | ICD10CM | Covered |
| D61.818 | ICD10CM | Covered |
| D61.82 | ICD10CM | Covered |
| D61.89 | ICD10CM | Covered |
| D61.9 | ICD10CM | Covered |
| D64.81 | ICD10CM | Covered |
| D64.89 | ICD10CM | Covered |
| D70.0 | ICD10CM | Covered |
| D70.1 | ICD10CM | Covered |
| D70.2 | ICD10CM | Covered |
| D70.3 | ICD10CM | Covered |
| D70.4 | ICD10CM | Covered |
| D70.9 | ICD10CM | Covered |
| D80.0 | ICD10CM | Covered |
| D80.1 | ICD10CM | Covered |
| D80.2 | ICD10CM | Covered |
| D80.3 | ICD10CM | Covered |
| D80.4 | ICD10CM | Covered |
| D80.5 | ICD10CM | Covered |
| D80.6 | ICD10CM | Covered |
| D80.8 | ICD10CM | Covered |
| D80.9 | ICD10CM | Covered |
| D81.0 | ICD10CM | Covered |
| D81.1 | ICD10CM | Covered |
| D81.2 | ICD10CM | Covered |
| D81.30 | ICD10CM | Covered |
| D81.31 | ICD10CM | Covered |
| D81.32 | ICD10CM | Covered |
| D81.39 | ICD10CM | Covered |
| D81.4 | ICD10CM | Covered |
| D81.5 | ICD10CM | Covered |
| D81.6 | ICD10CM | Covered |
| D81.7 | ICD10CM | Covered |
| D81.810 | ICD10CM | Covered |
| D81.818 | ICD10CM | Covered |
| D81.82 | ICD10CM | Covered |
| D81.89 | ICD10CM | Covered |
| D81.9 | ICD10CM | Covered |
| D82.0 | ICD10CM | Covered |
| D82.1 | ICD10CM | Covered |
| D82.2 | ICD10CM | Covered |
| D82.3 | ICD10CM | Covered |
| D82.4 | ICD10CM | Covered |
| D82.8 | ICD10CM | Covered |
| D83.0 | ICD10CM | Covered |
| D83.1 | ICD10CM | Covered |
| D83.2 | ICD10CM | Covered |
| D83.8 | ICD10CM | Covered |
| D83.9 | ICD10CM | Covered |
| D84.0 | ICD10CM | Covered |
| D84.1 | ICD10CM | Covered |
| D84.821 | ICD10CM | Covered |
| D84.822 | ICD10CM | Covered |
| D84.89 | ICD10CM | Covered |
| D84.9 | ICD10CM | Covered |
| D89.0 | ICD10CM | Covered |
| D89.1 | ICD10CM | Covered |
| D89.3 | ICD10CM | Covered |
| D89.41 | ICD10CM | Covered |
| D89.42 | ICD10CM | Covered |
| D89.43 | ICD10CM | Covered |
| D89.44 | ICD10CM | Covered |
| D89.49 | ICD10CM | Covered |
| D89.810 | ICD10CM | Covered |
| D89.811 | ICD10CM | Covered |
| D89.812 | ICD10CM | Covered |
| D89.813 | ICD10CM | Covered |
| D89.82 | ICD10CM | Covered |
| D89.89 | ICD10CM | Covered |
| E08.43 | ICD10CM | Covered |
| E10.43 | ICD10CM | Covered |
| E11.43 | ICD10CM | Covered |
| E13.43 | ICD10CM | Covered |
| E84.0 | ICD10CM | Covered |
| J05.0 | ICD10CM | Covered |
| J06.9 | ICD10CM | Covered |
| J09.X1 | ICD10CM | Covered |
| J09.X2 | ICD10CM | Covered |
| J09.X3 | ICD10CM | Covered |
| J09.X9 | ICD10CM | Covered |
| J10.01 | ICD10CM | Covered |
| J10.08 | ICD10CM | Covered |
| J10.1 | ICD10CM | Covered |
| J10.2 | ICD10CM | Covered |
| J10.81 | ICD10CM | Covered |
| J10.82 | ICD10CM | Covered |
| J10.83 | ICD10CM | Covered |
| J10.89 | ICD10CM | Covered |
| J11.08 | ICD10CM | Covered |
| J11.1 | ICD10CM | Covered |
| J11.2 | ICD10CM | Covered |
| J11.81 | ICD10CM | Covered |
| J11.82 | ICD10CM | Covered |
| J11.83 | ICD10CM | Covered |
| J11.89 | ICD10CM | Covered |
| J12.0 | ICD10CM | Covered |
| J12.1 | ICD10CM | Covered |
| J12.2 | ICD10CM | Covered |
| J12.3 | ICD10CM | Covered |
| J12.81 | ICD10CM | Covered |
| J12.82 | ICD10CM | Covered |
| J12.89 | ICD10CM | Covered |
| J12.9 | ICD10CM | Covered |
| J13 | ICD10CM | Covered |
| J15.0 | ICD10CM | Covered |
| J15.1 | ICD10CM | Covered |
| J15.20 | ICD10CM | Covered |
| J15.211 | ICD10CM | Covered |
| J15.212 | ICD10CM | Covered |
| J15.29 | ICD10CM | Covered |
| J15.3 | ICD10CM | Covered |
| J15.4 | ICD10CM | Covered |
| J15.61 | ICD10CM | Covered |
| J15.69 | ICD10CM | Covered |
| J15.7 | ICD10CM | Covered |
| J15.8 | ICD10CM | Covered |
| J15.9 | ICD10CM | Covered |
| J16.0 | ICD10CM | Covered |
| J16.8 | ICD10CM | Covered |
| J18.0 | ICD10CM | Covered |
| J18.1 | ICD10CM | Covered |
| J18.2 | ICD10CM | Covered |
| J18.8 | ICD10CM | Covered |
| J18.9 | ICD10CM | Covered |
| J20.0 | ICD10CM | Covered |
| J20.1 | ICD10CM | Covered |
| J20.2 | ICD10CM | Covered |
| J20.3 | ICD10CM | Covered |
| J20.4 | ICD10CM | Covered |
| J20.5 | ICD10CM | Covered |
| J20.6 | ICD10CM | Covered |
| J20.8 | ICD10CM | Covered |
| J20.9 | ICD10CM | Covered |
| J21.9 | ICD10CM | Covered |
| J22 | ICD10CM | Covered |
| J44.0 | ICD10CM | Covered |
| J44.1 | ICD10CM | Covered |
| J44.81 | ICD10CM | Covered |
| J44.89 | ICD10CM | Covered |
| J44.9 | ICD10CM | Covered |
| J45.31 | ICD10CM | Covered |
| J45.32 | ICD10CM | Covered |
| J45.41 | ICD10CM | Covered |
| J45.42 | ICD10CM | Covered |
| J45.51 | ICD10CM | Covered |
| J45.52 | ICD10CM | Covered |
| J45.901 | ICD10CM | Covered |
| J45.902 | ICD10CM | Covered |
| J45.991 | ICD10CM | Covered |
| J70.1 | ICD10CM | Covered |
| J84.01 | ICD10CM | Covered |
| J84.02 | ICD10CM | Covered |
| J84.03 | ICD10CM | Covered |
| J84.10 | ICD10CM | Covered |
| J84.112 | ICD10CM | Covered |
| J84.114 | ICD10CM | Covered |
| J84.116 | ICD10CM | Covered |
| J84.117 | ICD10CM | Covered |
| J84.170 | ICD10CM | Covered |
| J84.178 | ICD10CM | Covered |
| J84.2 | ICD10CM | Covered |
| J84.81 | ICD10CM | Covered |
| J84.82 | ICD10CM | Covered |
| J84.89 | ICD10CM | Covered |
| J85.0 | ICD10CM | Covered |
| J85.1 | ICD10CM | Covered |
| J85.2 | ICD10CM | Covered |
| J85.3 | ICD10CM | Covered |
| O98.711 | ICD10CM | Covered |
| O98.712 | ICD10CM | Covered |
| O98.713 | ICD10CM | Covered |
| R05.1 | ICD10CM | Covered |
| R05.2 | ICD10CM | Covered |
| R05.3 | ICD10CM | Covered |
| R05.8 | ICD10CM | Covered |
| R06.02 | ICD10CM | Covered |
| T80.82XS | ICD10CM | Covered |
| Z51.11 | ICD10CM | Covered |
| Z92.850 | ICD10CM | Covered |
| Z92.858 | ICD10CM | Covered |
| Z92.86 | ICD10CM | Covered |
| Z94.0 | ICD10CM | Covered |
| Z94.1 | ICD10CM | Covered |
| Z94.2 | ICD10CM | Covered |
| Z94.3 | ICD10CM | Covered |
| Z94.4 | ICD10CM | Covered |
| Z94.5 | ICD10CM | Covered |
| Z94.6 | ICD10CM | Covered |
| Z94.81 | ICD10CM | Covered |
| Z94.82 | ICD10CM | Covered |
| Z94.83 | ICD10CM | Covered |
| Z94.84 | ICD10CM | Covered |
| Z94.89 | ICD10CM | Covered |