F03.94 coverage policies: Medicare and commercial payers

38 active Medicare policies list F03.94, 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 F03.94

LCD · PALMETTO-JJ-L39266

Cognitive Assessment and Care Plan Service

JJ · Effective Aug 28, 2022

LCD · PALMETTO-JM-L39266

Cognitive Assessment and Care Plan Service

JM · Effective Aug 28, 2022

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 · CGS-J15-L34353

Outpatient Psychiatry and Psychology Services

J15 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35101

Psychiatric Codes

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35101

Psychiatric Codes

JL · Effective Oct 1, 2015

LCD · FIRST_COAST-L33252

Psychiatric Diagnostic Evaluation and Psychotherapy Services

Commercial payer policies listing F03.94

2 policies from 2 payers

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

Anthem

Anthem policies listing F03.94, with the code’s status in each
Policy	Effective	Status of F03.94
Testing for Biochemical Markers for Alzheimer DiseasePayerPolicy · ANTHEM-LAB.00046	Jul 1, 2026	Covered

Cigna

Cigna policies listing F03.94, with the code’s status in each
Policy	Effective	Status of F03.94
Serum Folate and Red Blood Cell Folate TestingPayerPolicy · CIGNA-0567	Dec 15, 2025	Covered