G21.0 coverage policies: Medicare and commercial payers

32 active Medicare policies list G21.0, and 10 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.

Get free alerts for G21.0

Free account. Policy pages stay open to everyone.

Medicare policies listing G21.0

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 · 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-L35048

Nerve Conduction Studies and Electromyography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L35048

Nerve Conduction Studies and Electromyography

JM · Effective Oct 1, 2015

LCD · NOVITAS-JH-L34975

Neurophysiology Evoked Potentials (NEPs)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34975

Neurophysiology Evoked Potentials (NEPs)

JL · Effective Oct 1, 2015

LCD · CGS-J15-L34353

Outpatient Psychiatry and Psychology Services

J15 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35101

Psychiatric Codes

Commercial payer policies listing G21.0

10 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 G21.0, with the code’s status in each
Policy	Effective	Status of G21.0
Actigraphy and AccelerometryPayerPolicy · AETNA-CPB-0710	Oct 3, 2023	Covered
Motor Cortex StimulationPayerPolicy · AETNA-CPB-0755	Oct 6, 2023	Covered
Phototherapy for Psychiatric DisordersPayerPolicy · AETNA-CPB-0370	Jun 6, 2023	Covered
Pool Therapy, Aquatic Therapy or HydrotherapyPayerPolicy · AETNA-CPB-0174	Apr 7, 2023	Covered
Pulsed Electromagnetic StimulationPayerPolicy · AETNA-CPB-0175	Mar 14, 2023	Covered
Stereotactic RadiosurgeryPayerPolicy · AETNA-CPB-0083	Feb 8, 2023	Covered

Policy	Effective	Status of G21.0
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
Stereotactic Radiofrequency PallidotomyClinical Guideline · ANTHEM-CG-SURG-108	Apr 15, 2026	Covered