G40.101 coverage policies: Medicare and commercial payers

50 active Medicare policies list G40.101, and 7 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 G40.101

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

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 · 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-L33399

EEG â Ambulatory Monitoring

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33399

EEG â Ambulatory Monitoring

JK · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L39400

Magnesium

JJ · Effective Jan 22, 2023

LCD · PALMETTO-JM-L39400

Magnesium

JM · Effective Jan 22, 2023

LCD · NOVITAS-JH-L35049

Monitored Anesthesia Care

JH · Effective Oct 1, 2015

Commercial payer policies listing G40.101

7 policies from 3 payers

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

Aetna

Aetna policies listing G40.101, with the code’s status in each
Policy	Effective	Status of G40.101
Electroconvulsive TherapyPayerPolicy · AETNA-CPB-0445	Sep 21, 2023	Covered
Hospitalization for the Initiation of Ketogenic DietPayerPolicy · AETNA-CPB-0226	Apr 25, 2023	Covered
Magnetic Source Imaging/MagnetoencephalographyPayerPolicy · AETNA-CPB-0279	May 4, 2023	Covered
Vagus Nerve StimulationPayerPolicy · AETNA-CPB-0191	Feb 9, 2024	Covered