G37.4 coverage policies: Medicare and commercial payers

47 active Medicare policies list G37.4, 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 G37.4

LCD · PALMETTO-JJ-L33461

Implantable Infusion Pump

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33461

Implantable Infusion Pump

JM · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34220

Lumbar MRI

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34220

Lumbar MRI

JF · 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 · 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

Commercial payer policies listing G37.4

2 policies from 2 payers

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

Ambetter

Ambetter policies listing G37.4, with the code’s status in each
Policy	Effective	Status of G37.4
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered

Cigna

Cigna policies listing G37.4, with the code’s status in each
Policy	Effective	Status of G37.4
Electrodiagnostic Testing (EMG/NCV)PayerPolicy · CIGNA-CPG129	Sep 15, 2026	Covered