F25.0 coverage policies: Medicare and commercial payers

40 active Medicare policies list F25.0, and 5 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 F25.0

LCD · NOVITAS-JH-L35006

Controlled Substance Monitoring and Drugs of Abuse Testing

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35006

Controlled Substance Monitoring and Drugs of Abuse Testing

JL · 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 · CGS-J15-L34353

Outpatient Psychiatry and Psychology Services

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L39853

Outpatient Psychotherapy

JJ · Effective Oct 20, 2024

LCD · PALMETTO-JM-L39853

Outpatient Psychotherapy

JM · Effective Oct 20, 2024

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 F25.0

5 policies from 2 payers

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

Aetna

Aetna policies listing F25.0, with the code’s status in each
Policy	Effective	Status of F25.0
Electroconvulsive TherapyPayerPolicy · AETNA-CPB-0445	Sep 21, 2023	Covered
Quantitative EEG (Brain Mapping)PayerPolicy · AETNA-CPB-0221	Apr 25, 2023	Covered
Quantitative, Functional and Connectomic Analysis of Brain MRIPayerPolicy · AETNA-CPB-0739	Oct 4, 2023	Covered

Anthem

Anthem policies listing F25.0, with the code’s status in each
Policy	Effective	Status of F25.0
Outpatient Glycated Hemoglobin and Protein TestingClinical Guideline · ANTHEM-CG-LAB-25	Jul 1, 2026	Covered
Outpatient Laboratory-based Blood Glucose TestingClinical Guideline · ANTHEM-CG-LAB-30