Codes in this policy
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.
Codes this policy lists and each code’s status in the policy| Code | Code system | Status in this policy |
|---|
| 61885 | CPT | Not covered |
|---|
| 64553 | CPT | Not covered |
|---|
| 64555 | CPT | Not covered |
|---|
| 64568 | CPT | Not covered |
|---|
| 64569 | CPT | Not covered |
|---|
| 64575 | CPT | Not covered |
|---|
| 64590 | CPT | Not covered |
|---|
| C1767 | HCPCS | Not covered |
|---|
| C1778 | HCPCS | Not covered |
|---|
| L8679 | HCPCS | Not covered |
|---|
| L8680 | HCPCS | Not covered |
|---|
| L8685 | HCPCS | Not covered |
|---|
| L8686 | HCPCS | Not covered |
|---|
| F33.0 | ICD10CM | Not covered |
|---|
| F33.9 | ICD10CM | Not covered |
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