G90.09 coverage policies: Medicare and commercial payers

35 active Medicare policies list G90.09, 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 G90.09

LCD · NGS-J6-L36236

Autonomic Function Testing

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L36236

Autonomic Function Testing

JK · Effective Oct 1, 2015

LCD · WPS-J5-L35124

Autonomic Function Testing

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L35124

Autonomic Function Testing

J8 · Effective Oct 1, 2015

LCD · FIRST_COAST-L33609

Autonomic Function Tests

J9 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35395

Autonomic Function Tests

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35395

Autonomic Function Tests

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 · NORIDIAN-JE-L34315

Electrocardiograms

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34315

Commercial payer policies listing G90.09

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 G90.09, with the code’s status in each
Policy	Effective	Status of G90.09
Autonomic Testing / Sudomotor TestsPayerPolicy · AETNA-CPB-0485	Jul 13, 2023	Covered
Homocysteine TestingPayerPolicy · AETNA-CPB-0763	Oct 26, 2023	Covered
Routine Foot CarePayerPolicy · AETNA-CPB-0046	Mar 6, 2023	Covered

Anthem

Anthem policies listing G90.09, with the code’s status in each
Policy	Effective	Status of G90.09
Foot Care ServicesClinical Guideline · ANTHEM-CG-MED-92	Jan 6, 2026	Covered
Peripheral Nerve Blocks for Treatment of Neuropathic PainPayerPolicy · ANTHEM-SURG.00140	Apr 15, 2026