Commercial DFU
Medicare Advantage Follows Active LCD
Retired LCD Follows Commercial
Policy No.
2022T0592K
States
Grafix Core Q4132
Commercial – Not Covered
Medicare Advantage – Follows Active LCD
Retired LCD – Follows Commercial
Grafix PL/Prime Q4133
Commercial – Covered - DFU
Medicare Advantage – Follows Active LCD
Retired LCD – Follows Commercial