Medica policy
Add-On Code
Add-On Code is a public Medica policy (policy RP-F-595X, effective Nov 1, 2025). It lists 31 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
- Payer
- Medica
- Policy number
- RP-F-595X
- Effective
- Nov 1, 2025
- Line of business
- Commercial, Medicaid
- Source
- partner.medica.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes.
| Code | Other Medica policies |
|---|---|
| 15271 | Policies naming 15271 |
| 15272 | Policies naming 15272 |
| 15273 | Policies naming 15273 |
| 15274 | Policies naming 15274 |
| 15275 | Policies naming 15275 |
| 15276 | Policies naming 15276 |
| 15277 | Policies naming 15277 |
| 15278 | Policies naming 15278 |
| 15777 | Policies naming 15777 |
| C5271 | Policies naming C5271 |
| C5272 | Policies naming C5272 |
| C5273 | Policies naming C5273 |
| C5274 | Policies naming C5274 |
| C5275 | Policies naming C5275 |
| C5276 | Policies naming C5276 |
| C5277 | Policies naming C5277 |
| C5278 | Policies naming C5278 |
| Q4368 | Policies naming Q4368 |
| Q4369 | Policies naming Q4369 |
| Q4370 | Policies naming Q4370 |
| Q4371 | Policies naming Q4371 |
| Q4372 | Policies naming Q4372 |
| Q4373 | Policies naming Q4373 |
| Q4374 | Policies naming Q4374 |
| Q4375 | Policies naming Q4375 |
| Q4376 | Policies naming Q4376 |
| Q4377 | Policies naming Q4377 |
| Q4378 | Policies naming Q4378 |
| Q4379 | Policies naming Q4379 |
| Q4380 | Policies naming Q4380 |
| Q4382 | Policies naming Q4382 |