E22.0 coverage policies: Medicare and commercial payers

22 active Medicare policies list E22.0, and 2 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.

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Medicare policies listing E22.0

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

LCD · PALMETTO-JJ-L34417

CT of the Head

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34417

CT of the Head

JM · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35049

Monitored Anesthesia Care

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35049

Monitored Anesthesia Care

JL · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L37373

MRI and CT Scans of the Head and Neck

JE · Effective Oct 8, 2018

LCD · NORIDIAN-JF-L37373

MRI and CT Scans of the Head and Neck

JF · Effective Oct 8, 2018

LCD · PALMETTO-JJ-L33438

Octreotide Acetate for Injectable Suspension (SandostatinÂ® LAR Depot)

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33438

Octreotide Acetate for Injectable Suspension (SandostatinÂ® LAR Depot)

JM · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35035

Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

Commercial payer policies listing E22.0

2 policies from 2 payers

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Ambetter

Ambetter policies listing E22.0, with the code’s status in each
Policy	Effective	Status of E22.0
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered

Anthem

Anthem policies listing E22.0, with the code’s status in each
Policy	Effective	Status of E22.0
Outpatient Laboratory-based Blood Glucose TestingClinical Guideline · ANTHEM-CG-LAB-30	Jul 1, 2026	Covered