Ambetter · PayerPolicy · AMBETTER-CP-MP-185
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 |
|---|---|---|
| 15271 | CPT | Covered |
| 15272 | CPT | Covered |
| 15273 | CPT | Covered |
| 15274 | CPT | Covered |
| 15275 | CPT | Covered |
| 15276 | CPT | Covered |
| 15277 | CPT | Covered |
| 15278 | CPT | Covered |
| A2001 | HCPCS | Covered |
| A2002 | HCPCS | Covered |
| A2003 | HCPCS | Covered |
| A2004 | HCPCS | Covered |
| A2005 | HCPCS | Covered |
| A2006 | HCPCS | Covered |
| A2007 | HCPCS | Covered |
| A2008 | HCPCS | Covered |
| A2009 | HCPCS | Covered |
| A2010 | HCPCS | Covered |
| A2011 | HCPCS | Covered |
| A2012 | HCPCS | Covered |
| A2013 | HCPCS | Covered |
| A2014 | HCPCS | Covered |
| A2015 | HCPCS | Covered |
| A2016 | HCPCS | Covered |
| A2017 | HCPCS | Covered |
| A2018 | HCPCS | Covered |
| A2019 | HCPCS | Covered |
| A2020 | HCPCS | Covered |
| A2021 | HCPCS | Covered |
| A2022 | HCPCS | Covered |
| A2023 | HCPCS | Covered |
| A2024 | HCPCS | Covered |
| A2025 | HCPCS | Covered |
| A2026 | HCPCS | Covered |
| A2027 | HCPCS | Covered |
| A2028 | HCPCS | Covered |
| A2029 | HCPCS | Covered |
| A2030 | HCPCS | Covered |
| A2031 | HCPCS | Covered |
| A2032 | HCPCS | Covered |
| A2033 | HCPCS | Covered |
| A2034 | HCPCS | Covered |
| A2035 | HCPCS | Covered |
| A2036 | HCPCS | Covered |
| A2037 | HCPCS | Covered |
| A2038 | HCPCS | Covered |
| A2039 | HCPCS | Covered |
| A4225 | HCPCS | Covered |
| C8002 | HCPCS | Covered |
| C9358 | HCPCS | Covered |
| C9360 | HCPCS | Covered |
| C9363 | HCPCS | Covered |
| C9364 | HCPCS | Covered |
| Q4100 | HCPCS | Covered |
| Q4101 | HCPCS | Covered |
| Q4102 | HCPCS | Covered |
| Q4103 | HCPCS | Covered |
| Q4104 | HCPCS | Covered |
| Q4105 | HCPCS | Covered |
| Q4106 | HCPCS | Covered |
| Q4107 | HCPCS | Covered |
| Q4108 | HCPCS | Covered |
| Q4110 | HCPCS | Covered |
| Q4111 | HCPCS | Covered |
| Q4112 | HCPCS | Covered |
| Q4113 | HCPCS | Covered |
| Q4114 | HCPCS | Covered |
| Q4115 | HCPCS | Covered |
| Q4116 | HCPCS | Covered |
| Q4117 | HCPCS | Covered |
| Q4118 | HCPCS | Covered |
| Q4119 | HCPCS | Covered |
| Q4121 | HCPCS | Covered |
| Q4122 | HCPCS | Covered |
| Q4123 | HCPCS | Covered |
| Q4124 | HCPCS | Covered |
| Q4125 | HCPCS | Covered |
| Q4126 | HCPCS | Covered |
| Q4127 | HCPCS | Covered |
| Q4128 | HCPCS | Covered |
| Q4130 | HCPCS | Covered |
| Q4132 | HCPCS | Covered |
| Q4133 | HCPCS | Covered |
| Q4134 | HCPCS | Covered |
| Q4135 | HCPCS | Covered |
| Q4136 | HCPCS | Covered |
| Q4137 | HCPCS | Covered |
| Q4138 | HCPCS | Covered |
| Q4139 | HCPCS | Covered |
| Q4140 | HCPCS | Covered |
| Q4141 | HCPCS | Covered |
| Q4142 | HCPCS | Covered |
| Q4143 | HCPCS | Covered |
| Q4145 | HCPCS | Covered |
| Q4146 | HCPCS | Covered |
| Q4147 | HCPCS | Covered |
| Q4148 | HCPCS | Covered |
| Q4149 | HCPCS | Covered |
| Q4150 | HCPCS | Covered |
| Q4151 | HCPCS | Covered |
| Q4152 | HCPCS | Covered |
| Q4153 | HCPCS | Covered |
| Q4154 | HCPCS | Covered |
| Q4155 | HCPCS | Covered |
| Q4156 | HCPCS | Covered |
| Q4157 | HCPCS | Covered |
| Q4158 | HCPCS | Covered |
| Q4159 | HCPCS | Covered |
| Q4160 | HCPCS | Covered |
| Q4161 | HCPCS | Covered |
| Q4162 | HCPCS | Covered |
| Q4163 | HCPCS | Covered |
| Q4164 | HCPCS | Covered |
| Q4165 | HCPCS | Covered |
| Q4166 | HCPCS | Covered |
| Q4167 | HCPCS | Covered |
| Q4168 | HCPCS | Covered |
| Q4169 | HCPCS | Covered |
| Q4170 | HCPCS | Covered |
| Q4171 | HCPCS | Covered |
| Q4173 | HCPCS | Covered |
| Q4174 | HCPCS | Covered |
| Q4175 | HCPCS | Covered |
| Q4176 | HCPCS | Covered |
| Q4177 | HCPCS | Covered |
| Q4178 | HCPCS | Covered |
| Q4179 | HCPCS | Covered |
| Q4180 | HCPCS | Covered |
| Q4181 | HCPCS | Covered |
| Q4182 | HCPCS | Covered |
| Q4183 | HCPCS | Covered |
| Q4184 | HCPCS | Covered |
| Q4185 | HCPCS | Covered |
| Q4186 | HCPCS | Covered |
| Q4187 | HCPCS | Covered |
| Q4188 | HCPCS | Covered |
| Q4189 | HCPCS | Covered |
| Q4190 | HCPCS | Covered |
| Q4191 | HCPCS | Covered |
| Q4192 | HCPCS | Covered |
| Q4193 | HCPCS | Covered |
| Q4194 | HCPCS | Covered |
| Q4195 | HCPCS | Covered |
| Q4196 | HCPCS | Covered |
| Q4197 | HCPCS | Covered |
| Q4198 | HCPCS | Covered |
| Q4199 | HCPCS | Covered |
| Q4200 | HCPCS | Covered |
| Q4201 | HCPCS | Covered |
| Q4202 | HCPCS | Covered |
| Q4203 | HCPCS | Covered |
| Q4204 | HCPCS | Covered |
| Q4205 | HCPCS | Covered |
| Q4206 | HCPCS | Covered |
| Q4208 | HCPCS | Covered |
| Q4209 | HCPCS | Covered |
| Q4210 | HCPCS | Covered |
| Q4211 | HCPCS | Covered |
| Q4212 | HCPCS | Covered |
| Q4213 | HCPCS | Covered |
| Q4214 | HCPCS | Covered |
| Q4215 | HCPCS | Covered |
| Q4216 | HCPCS | Covered |
| Q4217 | HCPCS | Covered |
| Q4218 | HCPCS | Covered |
| Q4219 | HCPCS | Covered |
| Q4220 | HCPCS | Covered |
| Q4221 | HCPCS | Covered |
| Q4222 | HCPCS | Covered |
| Q4223 | HCPCS | Covered |
| Q4224 | HCPCS | Covered |
| Q4225 | HCPCS | Covered |
| Q4226 | HCPCS | Covered |
| Q4227 | HCPCS | Covered |
| Q4229 | HCPCS | Covered |
| Q4230 | HCPCS | Covered |
| Q4231 | HCPCS | Covered |
| Q4232 | HCPCS | Covered |
| Q4233 | HCPCS | Covered |
| Q4234 | HCPCS | Covered |
| Q4235 | HCPCS | Covered |
| Q4236 | HCPCS | Covered |
| Q4237 | HCPCS | Covered |
| Q4238 | HCPCS | Covered |
| Q4239 | HCPCS | Covered |
| Q4240 | HCPCS | Covered |
| Q4241 | HCPCS | Covered |
| Q4242 | HCPCS | Covered |
| Q4244 | HCPCS | Covered |
| Q4245 | HCPCS | Covered |
| Q4246 | HCPCS | Covered |
| Q4247 | HCPCS | Covered |
| Q4248 | HCPCS | Covered |
| Q4249 | HCPCS | Covered |
| Q4250 | HCPCS | Covered |
| Q4251 | HCPCS | Covered |
| Q4252 | HCPCS | Covered |
| Q4253 | HCPCS | Covered |
| Q4254 | HCPCS | Covered |
| Q4255 | HCPCS | Covered |
| Q4256 | HCPCS | Covered |
| Q4257 | HCPCS | Covered |
| Q4258 | HCPCS | Covered |
| Q4259 | HCPCS | Covered |
| Q4260 | HCPCS | Covered |
| Q4261 | HCPCS | Covered |
| Q4262 | HCPCS | Covered |
| Q4263 | HCPCS | Covered |
| Q4264 | HCPCS | Covered |
| Q4265 | HCPCS | Covered |
| Q4266 | HCPCS | Covered |
| Q4267 | HCPCS | Covered |
| Q4268 | HCPCS | Covered |
| Q4269 | HCPCS | Covered |
| Q4270 | HCPCS | Covered |
| Q4271 | HCPCS | Covered |
| Q4272 | HCPCS | Covered |
| Q4273 | HCPCS | Covered |
| Q4274 | HCPCS | Covered |
| Q4275 | HCPCS | Covered |
| Q4276 | HCPCS | Covered |
| Q4278 | HCPCS | Covered |
| Q4279 | HCPCS | Covered |
| Q4280 | HCPCS | Covered |
| Q4281 | HCPCS | Covered |
| Q4282 | HCPCS | Covered |
| Q4283 | HCPCS | Covered |
| Q4284 | HCPCS | Covered |
| Q4285 | HCPCS | Covered |
| Q4286 | HCPCS | Covered |
| Q4287 | HCPCS | Covered |
| Q4288 | HCPCS | Covered |
| Q4289 | HCPCS | Covered |
| Q4290 | HCPCS | Covered |
| Q4291 | HCPCS | Covered |
| Q4292 | HCPCS | Covered |
| Q4293 | HCPCS | Covered |
| Q4294 | HCPCS | Covered |
| Q4295 | HCPCS | Covered |
| Q4296 | HCPCS | Covered |
| Q4297 | HCPCS | Covered |
| Q4298 | HCPCS | Covered |
| Q4299 | HCPCS | Covered |
| Q4300 | HCPCS | Covered |
| Q4301 | HCPCS | Covered |
| Q4302 | HCPCS | Covered |
| Q4303 | HCPCS | Covered |
| Q4304 | HCPCS | Covered |
| Q4305 | HCPCS | Covered |
| Q4306 | HCPCS | Covered |
| Q4307 | HCPCS | Covered |
| Q4308 | HCPCS | Covered |
| Q4309 | HCPCS | Covered |
| Q4310 | HCPCS | Covered |
| Q4311 | HCPCS | Covered |
| Q4312 | HCPCS | Covered |
| Q4313 | HCPCS | Covered |
| Q4314 | HCPCS | Covered |
| Q4315 | HCPCS | Covered |
| Q4316 | HCPCS | Covered |
| Q4317 | HCPCS | Covered |
| Q4318 | HCPCS | Covered |
| Q4319 | HCPCS | Covered |
| Q4320 | HCPCS | Covered |
| Q4321 | HCPCS | Covered |
| Q4322 | HCPCS | Covered |
| Q4323 | HCPCS | Covered |
| Q4324 | HCPCS | Covered |
| Q4325 | HCPCS | Covered |
| Q4326 | HCPCS | Covered |
| Q4327 | HCPCS | Covered |
| Q4328 | HCPCS | Covered |
| Q4329 | HCPCS | Covered |
| Q4330 | HCPCS | Covered |
| Q4331 | HCPCS | Covered |
| Q4332 | HCPCS | Covered |
| Q4333 | HCPCS | Covered |
| Q4334 | HCPCS | Covered |
| Q4335 | HCPCS | Covered |
| Q4336 | HCPCS | Covered |
| Q4337 | HCPCS | Covered |
| Q4338 | HCPCS | Covered |
| Q4339 | HCPCS | Covered |
| Q4340 | HCPCS | Covered |
| Q4341 | HCPCS | Covered |
| Q4342 | HCPCS | Covered |
| Q4343 | HCPCS | Covered |
| Q4344 | HCPCS | Covered |
| Q4345 | HCPCS | Covered |
| Q4346 | HCPCS | Covered |
| Q4347 | HCPCS | Covered |
| Q4348 | HCPCS | Covered |
| Q4349 | HCPCS | Covered |
| Q4350 | HCPCS | Covered |
| Q4351 | HCPCS | Covered |
| Q4352 | HCPCS | Covered |
| Q4353 | HCPCS | Covered |
| Q4354 | HCPCS | Covered |
| Q4355 | HCPCS | Covered |
| Q4356 | HCPCS | Covered |
| Q4357 | HCPCS | Covered |
| Q4358 | HCPCS | Covered |
| Q4359 | HCPCS | Covered |
| Q4360 | HCPCS | Covered |
| Q4361 | HCPCS | Covered |
| Q4362 | HCPCS | Covered |
| Q4363 | HCPCS | Covered |
| Q4364 | HCPCS | Covered |
| Q4365 | HCPCS | Covered |
| Q4366 | HCPCS | Covered |
| Q4367 | HCPCS | Covered |
| Q4368 | HCPCS | Covered |
| Q4369 | HCPCS | Covered |
| Q4370 | HCPCS | Covered |
| Q4371 | HCPCS | Covered |
| Q4372 | HCPCS | Covered |
| Q4373 | HCPCS | Covered |
| Q4375 | HCPCS | Covered |
| Q4376 | HCPCS | Covered |
| Q4377 | HCPCS | Covered |
| Q4378 | HCPCS | Covered |
| Q4379 | HCPCS | Covered |
| Q4380 | HCPCS | Covered |
| Q4382 | HCPCS | Covered |
| Q4383 | HCPCS | Covered |
| Q4384 | HCPCS | Covered |
| Q4385 | HCPCS | Covered |
| Q4386 | HCPCS | Covered |
| Q4387 | HCPCS | Covered |
| Q4388 | HCPCS | Covered |
| Q4389 | HCPCS | Covered |
| Q4390 | HCPCS | Covered |
| Q4391 | HCPCS | Covered |
| Q4392 | HCPCS | Covered |
| Q4393 | HCPCS | Covered |
| Q4394 | HCPCS | Covered |
| Q4395 | HCPCS | Covered |
| Q4396 | HCPCS | Covered |
| Q4397 | HCPCS | Covered |