G95.20 coverage policies: Medicare and commercial payers

32 active Medicare policies list G95.20, and 1 commercial payer policy lists 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 G95.20

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 · FIRST_COAST-L34859

Nerve Conduction Studies and Electromyography

J9 · 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 · NOVITAS-JH-L35081

Nerve Conduction Studies and Electromyography

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35081

Nerve Conduction Studies and Electromyography

JL · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L35048

Nerve Conduction Studies and Electromyography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L35048

Nerve Conduction Studies and Electromyography

JM · Effective Oct 1, 2015

LCD · NGS-J6-L35075

Proton Beam Therapy

Commercial payer policies listing G95.20

1 policy from 1 payer

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

Cigna

Cigna policies listing G95.20, with the code’s status in each
Policy	Effective	Status of G95.20
Electrodiagnostic Testing (EMG/NCV)PayerPolicy · CIGNA-CPG129	Sep 15, 2026	Covered