G62.89 coverage policies: Medicare and commercial payers

55 active Medicare policies list G62.89, and 4 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 G62.89

Free account. Policy pages stay open to everyone.

Medicare policies listing G62.89

LCD · CGS-J15-L35891

Intravenous Immune Globulin

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34580

Intravenous Immunoglobulin (IVIG)

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34580

Intravenous Immunoglobulin (IVIG)

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 · NORIDIAN-JE-L35456

Nerve Blockade for Treatment of Chronic Pain and Neuropathy

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L35456

Nerve Blockade for Treatment of Chronic Pain and Neuropathy

JF · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L37642

Nerve Blocks and Electrostimulation for Peripheral Neuropathy

JJ · Effective Jan 29, 2018

LCD · PALMETTO-JM-L37642

Nerve Blocks and Electrostimulation for Peripheral Neuropathy

JM · Effective Jan 29, 2018

LCD · CGS-J15-L35897

Commercial payer policies listing G62.89

4 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 G62.89, with the code’s status in each
Policy	Effective	Status of G62.89
Antibody Tests for Neurologic DiseasesPayerPolicy · AETNA-CPB-0340	Feb 15, 2024	Covered
Electrodiagnostic TestingPayerPolicy · AETNA-CPB-0502	Aug 1, 2023	Covered
Quantitative Sensory Testing MethodsPayerPolicy · AETNA-CPB-0357	Jun 5, 2023	Covered

Cigna

Cigna policies listing G62.89, with the code’s status in each
Policy	Effective	Status of G62.89
Serum Folate and Red Blood Cell Folate TestingPayerPolicy · CIGNA-0567	Dec 15, 2025	Covered