H49.21 coverage policies: Medicare and commercial payers

72 active Medicare policies list H49.21, 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 H49.21

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

LCD · CGS-J15-L39856

Botulinum Toxin Injections

J15

LCD · CGS-J15-L39857

Botulinum Toxin Injections

J15 · Effective Feb 22, 2026

LCD · NGS-J6-L39832

Botulinum Toxin Injections

J6 · Effective Feb 22, 2026

LCD · NGS-JK-L39832

Botulinum Toxin Injections

JK · Effective Feb 22, 2026

LCD · NORIDIAN-L35170

Botulinum Toxin Injections

JE · Effective Oct 1, 2015

LCD · NORIDIAN-L35172

Botulinum Toxin Injections

JF · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L39836

Botulinum Toxin Injections

JJ · Effective Feb 22, 2026

LCD · PALMETTO-JM-L39836

Botulinum Toxin Injections

JM · Effective Feb 22, 2026

LCD · WPS-J5-L39908

Botulinum Toxin Injections

LCD · WPS-J5-L39909

Commercial payer policies listing H49.21

1 policy from 1 payer

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

Ambetter

Ambetter policies listing H49.21, with the code’s status in each
Policy	Effective	Status of H49.21
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered