G45.4 coverage policies: Medicare and commercial payers

35 active Medicare policies list G45.4, and 3 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 G45.4

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 · WPS-J5-L34636

Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L34636

Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J8 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35049

Monitored Anesthesia Care

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35049

Monitored Anesthesia Care

JL · 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 · NOVITAS-JH-L35397

Non-Invasive Cerebrovascular Arterial Studies

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35397

Non-Invasive Cerebrovascular Arterial Studies

Commercial payer policies listing G45.4

3 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 G45.4, with the code’s status in each
Policy	Effective	Status of G45.4
Jaw Motion Rehabilitation SystemsPayerPolicy · AETNA-CPB-0412	Jun 7, 2023	Covered
Quantitative, Functional and Connectomic Analysis of Brain MRIPayerPolicy · AETNA-CPB-0739	Oct 4, 2023	Covered

Ambetter

Ambetter policies listing G45.4, with the code’s status in each
Policy	Effective	Status of G45.4
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered