G12.23 coverage policies: Medicare and commercial payers

38 active Medicare policies list G12.23, 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 G12.23

LCD · WPS-J5-L35124

Autonomic Function Testing

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L35124

Autonomic Function Testing

J8 · 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-L35897

Nerve Conduction Studies and Electromyography

J15 · Effective Oct 1, 2015

LCD · FIRST_COAST-L34859

Nerve Conduction Studies and Electromyography

J9 · Effective Oct 1, 2015

LCD · NGS-J6-L35098

Nerve Conduction Studies and Electromyography

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L35098

Nerve Conduction Studies and Electromyography

JK · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L36524

Nerve Conduction Studies and Electromyography

JE · Effective Jun 1, 2016

LCD · NORIDIAN-JF-L36524

Nerve Conduction Studies and Electromyography

Commercial payer policies listing G12.23

5 policies from 4 payers

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

Cigna

Cigna policies listing G12.23, with the code’s status in each
Policy	Effective	Status of G12.23
Airway Clearance Devices in the Ambulatory SettingPayerPolicy · CIGNA-0069	Nov 9, 2025	Covered
Electrodiagnostic Testing (EMG/NCV)PayerPolicy · CIGNA-CPG129	Sep 15, 2026	Covered

Aetna

Aetna policies listing G12.23, with the code’s status in each
Policy	Effective	Status of G12.23
Ziconotide (Prialt)PayerPolicy · AETNA-CPB-0712	Sep 21, 2023	Covered

Ambetter

Ambetter policies listing G12.23, with the code’s status in each
Policy	Effective	Status of G12.23
Pulmonary Function Testing