Ambetter · PayerPolicy · AMBETTER-CP-MP-31
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 |
|---|---|---|
| 11200 | CPT | Covered |
| 11201 | CPT | Covered |
| 11310 | CPT | Covered |
| 11400 | CPT | Covered |
| 11401 | CPT | Covered |
| 11402 | CPT | Covered |
| 11403 | CPT | Covered |
| 11404 | CPT | Covered |
| 11406 | CPT | Covered |
| 11420 | CPT | Covered |
| 11421 | CPT | Covered |
| 11422 | CPT | Covered |
| 11423 | CPT | Covered |
| 11424 | CPT | Covered |
| 11426 | CPT | Covered |
| 11440 | CPT | Covered |
| 11441 | CPT | Covered |
| 11442 | CPT | Covered |
| 11443 | CPT | Covered |
| 11444 | CPT | Covered |
| 11446 | CPT | Covered |
| 11920 | CPT | Covered |
| 11921 | CPT | Covered |
| 11922 | CPT | Covered |
| 15220 | CPT | Covered |
| 15221 | CPT | Covered |
| 15771 | CPT | Covered |
| 15772 | CPT | Covered |
| 15773 | CPT | Covered |
| 15774 | CPT | Covered |
| 15775 | CPT | Covered |
| 15776 | CPT | Covered |
| 15788 | CPT | Covered |
| 15789 | CPT | Covered |
| 15792 | CPT | Covered |
| 15793 | CPT | Covered |
| 15830 | CPT | Covered |
| 15832 | CPT | Covered |
| 15833 | CPT | Covered |
| 15834 | CPT | Covered |
| 15835 | CPT | Covered |
| 15836 | CPT | Covered |
| 15837 | CPT | Covered |
| 15838 | CPT | Covered |
| 15839 | CPT | Covered |
| 15847 | CPT | Covered |
| 15876 | CPT | Covered |
| 15877 | CPT | Covered |
| 15878 | CPT | Covered |
| 15879 | CPT | Covered |
| 17110 | CPT | Covered |
| 17111 | CPT | Covered |
| 19301 | CPT | Covered |
| 19302 | CPT | Covered |
| 19303 | CPT | Covered |
| 19316 | CPT | Covered |
| 19318 | CPT | Covered |
| 19324 | CPT | Covered |
| 19325 | CPT | Covered |
| 19328 | CPT | Covered |
| 19330 | CPT | Covered |
| 19340 | CPT | Covered |
| 19342 | CPT | Covered |
| 19350 | CPT | Covered |
| 19355 | CPT | Covered |
| 19357 | CPT | Covered |
| 19361 | CPT | Covered |
| 19364 | CPT | Covered |
| 19366 | CPT | Covered |
| 19367 | CPT | Covered |
| 19368 | CPT | Covered |
| 19369 | CPT | Covered |
| 19370 | CPT | Covered |
| 19371 | CPT | Covered |
| 19380 | CPT | Covered |
| 19396 | CPT | Covered |
| 19499 | CPT | Covered |
| 21120 | CPT | Covered |
| 21121 | CPT | Covered |
| 21122 | CPT | Covered |
| 21123 | CPT | Covered |
| 21137 | CPT | Covered |
| 21138 | CPT | Covered |
| 21139 | CPT | Covered |
| 21159 | CPT | Covered |
| 21160 | CPT | Covered |
| 21172 | CPT | Covered |
| 21175 | CPT | Covered |
| 21179 | CPT | Covered |
| 21180 | CPT | Covered |
| 21181 | CPT | Covered |
| 21182 | CPT | Covered |
| 21183 | CPT | Covered |
| 21184 | CPT | Covered |
| 21230 | CPT | Covered |
| 21235 | CPT | Covered |
| 21255 | CPT | Covered |
| 21256 | CPT | Covered |
| 21260 | CPT | Covered |
| 21261 | CPT | Covered |
| 21263 | CPT | Covered |
| 21267 | CPT | Covered |
| 21268 | CPT | Covered |
| 21270 | CPT | Covered |
| 21275 | CPT | Covered |
| 21280 | CPT | Covered |
| 21282 | CPT | Covered |
| 21295 | CPT | Covered |
| 21296 | CPT | Covered |
| 61550 | CPT | Covered |
| 61552 | CPT | Covered |
| 61556 | CPT | Covered |
| 61557 | CPT | Covered |
| 61558 | CPT | Covered |
| 61559 | CPT | Covered |
| G0429 | HCPCS | Covered |
| Q2026 | HCPCS | Covered |
| Q2028 | HCPCS | Covered |