BCBS Montana · PayerPolicy · BCBSMT-DME104.012
Summary of the payer’s published policy. Not a coverage determination — confirm with BCBS Montana 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 |
|---|---|---|
| 97110 | CPT | Covered |
| 97112 | CPT | Covered |
| 97116 | CPT | Covered |
| 97761 | CPT | Covered |
| 97762 | CPT | Covered |
| 97763 | CPT | Covered |
| L2221 | HCPCS | Covered |
| L5000 | HCPCS | Covered |
| L5010 | HCPCS | Covered |
| L5020 | HCPCS | Covered |
| L5050 | HCPCS | Covered |
| L5060 | HCPCS | Covered |
| L5100 | HCPCS | Covered |
| L5105 | HCPCS | Covered |
| L5150 | HCPCS | Covered |
| L5160 | HCPCS |
| Covered |
| L5200 | HCPCS | Covered |
|---|
| L5210 | HCPCS | Covered |
|---|
| L5220 | HCPCS | Covered |
|---|
| L5230 | HCPCS | Covered |
|---|
| L5250 | HCPCS | Covered |
|---|
| L5270 | HCPCS | Covered |
|---|
| L5280 | HCPCS | Covered |
|---|
| L5301 | HCPCS | Covered |
|---|
| L5312 | HCPCS | Covered |
|---|
| L5321 | HCPCS | Covered |
|---|
| L5331 | HCPCS | Covered |
|---|
| L5341 | HCPCS | Covered |
|---|
| L5400 | HCPCS | Covered |
|---|
| L5410 | HCPCS | Covered |
|---|
| L5420 | HCPCS | Covered |
|---|
| L5430 | HCPCS | Covered |
|---|
| L5450 | HCPCS | Covered |
|---|
| L5460 | HCPCS | Covered |
|---|
| L5500 | HCPCS | Covered |
|---|
| L5505 | HCPCS | Covered |
|---|
| L5510 | HCPCS | Covered |
|---|
| L5520 | HCPCS | Covered |
|---|
| L5530 | HCPCS | Covered |
|---|
| L5535 | HCPCS | Covered |
|---|
| L5540 | HCPCS | Covered |
|---|
| L5560 | HCPCS | Covered |
|---|
| L5570 | HCPCS | Covered |
|---|
| L5580 | HCPCS | Covered |
|---|
| L5585 | HCPCS | Covered |
|---|
| L5590 | HCPCS | Covered |
|---|
| L5595 | HCPCS | Covered |
|---|
| L5600 | HCPCS | Covered |
|---|
| L5610 | HCPCS | Covered |
|---|
| L5611 | HCPCS | Covered |
|---|
| L5613 | HCPCS | Covered |
|---|
| L5614 | HCPCS | Covered |
|---|
| L5615 | HCPCS | Covered |
|---|
| L5616 | HCPCS | Covered |
|---|
| L5617 | HCPCS | Covered |
|---|
| L5618 | HCPCS | Covered |
|---|
| L5620 | HCPCS | Covered |
|---|
| L5622 | HCPCS | Covered |
|---|
| L5624 | HCPCS | Covered |
|---|
| L5626 | HCPCS | Covered |
|---|
| L5628 | HCPCS | Covered |
|---|
| L5629 | HCPCS | Covered |
|---|
| L5630 | HCPCS | Covered |
|---|
| L5631 | HCPCS | Covered |
|---|
| L5632 | HCPCS | Covered |
|---|
| L5634 | HCPCS | Covered |
|---|
| L5636 | HCPCS | Covered |
|---|
| L5637 | HCPCS | Covered |
|---|
| L5638 | HCPCS | Covered |
|---|
| L5639 | HCPCS | Covered |
|---|
| L5640 | HCPCS | Covered |
|---|
| L5642 | HCPCS | Covered |
|---|
| L5643 | HCPCS | Covered |
|---|
| L5644 | HCPCS | Covered |
|---|
| L5645 | HCPCS | Covered |
|---|
| L5646 | HCPCS | Covered |
|---|
| L5647 | HCPCS | Covered |
|---|
| L5648 | HCPCS | Covered |
|---|
| L5649 | HCPCS | Covered |
|---|
| L5650 | HCPCS | Covered |
|---|
| L5651 | HCPCS | Covered |
|---|
| L5652 | HCPCS | Covered |
|---|
| L5653 | HCPCS | Covered |
|---|
| L5654 | HCPCS | Covered |
|---|
| L5655 | HCPCS | Covered |
|---|
| L5656 | HCPCS | Covered |
|---|
| L5658 | HCPCS | Covered |
|---|
| L5661 | HCPCS | Covered |
|---|
| L5665 | HCPCS | Covered |
|---|
| L5666 | HCPCS | Covered |
|---|
| L5668 | HCPCS | Covered |
|---|
| L5670 | HCPCS | Covered |
|---|
| L5671 | HCPCS | Covered |
|---|
| L5672 | HCPCS | Covered |
|---|
| L5673 | HCPCS | Covered |
|---|
| L5676 | HCPCS | Covered |
|---|
| L5677 | HCPCS | Covered |
|---|
| L5678 | HCPCS | Covered |
|---|
| L5679 | HCPCS | Covered |
|---|
| L5680 | HCPCS | Covered |
|---|
| L5681 | HCPCS | Covered |
|---|
| L5682 | HCPCS | Covered |
|---|
| L5683 | HCPCS | Covered |
|---|
| L5684 | HCPCS | Covered |
|---|
| L5685 | HCPCS | Covered |
|---|
| L5686 | HCPCS | Covered |
|---|
| L5688 | HCPCS | Covered |
|---|
| L5690 | HCPCS | Covered |
|---|
| L5692 | HCPCS | Covered |
|---|
| L5694 | HCPCS | Covered |
|---|
| L5695 | HCPCS | Covered |
|---|
| L5696 | HCPCS | Covered |
|---|
| L5697 | HCPCS | Covered |
|---|
| L5698 | HCPCS | Covered |
|---|
| L5699 | HCPCS | Covered |
|---|
| L5700 | HCPCS | Covered |
|---|
| L5701 | HCPCS | Covered |
|---|
| L5702 | HCPCS | Covered |
|---|
| L5703 | HCPCS | Covered |
|---|
| L5704 | HCPCS | Covered |
|---|
| L5705 | HCPCS | Covered |
|---|
| L5706 | HCPCS | Covered |
|---|
| L5707 | HCPCS | Covered |
|---|
| L5710 | HCPCS | Covered |
|---|
| L5711 | HCPCS | Covered |
|---|
| L5712 | HCPCS | Covered |
|---|
| L5714 | HCPCS | Covered |
|---|
| L5716 | HCPCS | Covered |
|---|
| L5718 | HCPCS | Covered |
|---|
| L5722 | HCPCS | Covered |
|---|
| L5724 | HCPCS | Covered |
|---|
| L5726 | HCPCS | Covered |
|---|
| L5728 | HCPCS | Covered |
|---|
| L5780 | HCPCS | Covered |
|---|
| L5781 | HCPCS | Covered |
|---|
| L5782 | HCPCS | Covered |
|---|
| L5783 | HCPCS | Covered |
|---|
| L5785 | HCPCS | Covered |
|---|
| L5790 | HCPCS | Covered |
|---|
| L5795 | HCPCS | Covered |
|---|
| L5810 | HCPCS | Covered |
|---|
| L5811 | HCPCS | Covered |
|---|
| L5812 | HCPCS | Covered |
|---|
| L5814 | HCPCS | Covered |
|---|
| L5816 | HCPCS | Covered |
|---|
| L5818 | HCPCS | Covered |
|---|
| L5822 | HCPCS | Covered |
|---|
| L5824 | HCPCS | Covered |
|---|
| L5826 | HCPCS | Covered |
|---|
| L5827 | HCPCS | Covered |
|---|
| L5828 | HCPCS | Covered |
|---|
| L5830 | HCPCS | Covered |
|---|
| L5840 | HCPCS | Covered |
|---|
| L5841 | HCPCS | Covered |
|---|
| L5845 | HCPCS | Covered |
|---|
| L5848 | HCPCS | Covered |
|---|
| L5850 | HCPCS | Covered |
|---|
| L5855 | HCPCS | Covered |
|---|
| L5856 | HCPCS | Covered |
|---|
| L5857 | HCPCS | Covered |
|---|
| L5858 | HCPCS | Covered |
|---|
| L5859 | HCPCS | Covered |
|---|
| L5910 | HCPCS | Covered |
|---|
| L5920 | HCPCS | Covered |
|---|
| L5925 | HCPCS | Covered |
|---|
| L5926 | HCPCS | Covered |
|---|
| L5930 | HCPCS | Covered |
|---|
| L5940 | HCPCS | Covered |
|---|
| L5950 | HCPCS | Covered |
|---|
| L5960 | HCPCS | Covered |
|---|
| L5961 | HCPCS | Covered |
|---|
| L5962 | HCPCS | Covered |
|---|
| L5964 | HCPCS | Covered |
|---|
| L5966 | HCPCS | Covered |
|---|
| L5968 | HCPCS | Covered |
|---|
| L5969 | HCPCS | Covered |
|---|
| L5970 | HCPCS | Covered |
|---|
| L5971 | HCPCS | Covered |
|---|
| L5972 | HCPCS | Covered |
|---|
| L5973 | HCPCS | Covered |
|---|
| L5974 | HCPCS | Covered |
|---|
| L5975 | HCPCS | Covered |
|---|
| L5976 | HCPCS | Covered |
|---|
| L5978 | HCPCS | Covered |
|---|
| L5979 | HCPCS | Covered |
|---|
| L5980 | HCPCS | Covered |
|---|
| L5981 | HCPCS | Covered |
|---|
| L5982 | HCPCS | Covered |
|---|
| L5984 | HCPCS | Covered |
|---|
| L5985 | HCPCS | Covered |
|---|
| L5986 | HCPCS | Covered |
|---|
| L5987 | HCPCS | Covered |
|---|
| L5988 | HCPCS | Covered |
|---|
| L5990 | HCPCS | Covered |
|---|
| L5991 | HCPCS | Covered |
|---|
| L5992 | HCPCS | Covered |
|---|
| L5999 | HCPCS | Covered |
|---|
| L7360 | HCPCS | Covered |
|---|
| L7362 | HCPCS | Covered |
|---|
| L7367 | HCPCS | Covered |
|---|
| L7368 | HCPCS | Covered |
|---|
| L7500 | HCPCS | Covered |
|---|
| L7510 | HCPCS | Covered |
|---|
| L7520 | HCPCS | Covered |
|---|
| L7600 | HCPCS | Covered |
|---|
| L7700 | HCPCS | Covered |
|---|
| L8400 | HCPCS | Covered |
|---|
| L8410 | HCPCS | Covered |
|---|
| L8415 | HCPCS | Covered |
|---|
| L8417 | HCPCS | Covered |
|---|
| L8420 | HCPCS | Covered |
|---|
| L8430 | HCPCS | Covered |
|---|
| L8435 | HCPCS | Covered |
|---|
| L8440 | HCPCS | Covered |
|---|
| L8460 | HCPCS | Covered |
|---|
| L8465 | HCPCS | Covered |
|---|
| L8470 | HCPCS | Covered |
|---|
| L8480 | HCPCS | Covered |
|---|
| L8485 | HCPCS | Covered |
|---|
| L8499 | HCPCS | Covered |
|---|