G20.C coverage policies: Medicare and commercial payers

36 active Medicare policies list G20.C, and 6 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 G20.C

LCD · NGS-J6-L36236

Autonomic Function Testing

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L36236

Autonomic Function Testing

JK · Effective Oct 1, 2015

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 · 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 · NGS-J6-L37421

Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor

J6 · Effective Apr 1, 2018

LCD · NGS-J6-L40279

Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor

LCD · NGS-JK-L37421

Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor

JK · Effective Apr 1, 2018

LCD · NGS-JK-L40279

Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor

Commercial payer policies listing G20.C

6 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 G20.C, with the code’s status in each
Policy	Effective	Status of G20.C
Cell Transplantation (Mesencephalic, Adrenal-Brain and Fetal Xenograft)PayerPolicy · ANTHEM-TRANS.00004	Apr 15, 2026	Not covered
Deep Brain Stimulation and Responsive NeurostimulationPayerPolicy · ANTHEM-SURG.00026	Oct 1, 2026	Covered
MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic IndicationsPayerPolicy · ANTHEM-MED.00057	Oct 1, 2026	Covered
Stereotactic Radiofrequency PallidotomyClinical Guideline · ANTHEM-CG-SURG-108	Apr 15, 2026	Covered

Aetna

Aetna policies listing G20.C, with the code’s status in each
Policy	Effective	Status of G20.C
Pulsed Electromagnetic Stimulation