H90.42 coverage policies: Medicare and commercial payers

27 active Medicare policies list H90.42, and 2 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 H90.42

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-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-L34975

Neurophysiology Evoked Potentials (NEPs)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34975

Neurophysiology Evoked Potentials (NEPs)

JL · Effective Oct 1, 2015

LCD · CGS-J15-L34353

Outpatient Psychiatry and Psychology Services

J15 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35070

Speech - Language Pathology (SLP) Services: Communication Disorders

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35070

Speech - Language Pathology (SLP) Services: Communication Disorders

JL · Effective Oct 1, 2015

LCD · CGS-J15-L34046

Speech-Language Pathology

Commercial payer policies listing H90.42

2 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 H90.42, with the code’s status in each
Policy	Effective	Status of H90.42
Electrocochleogram and Perilymphatic Pressure MeasurementPayerPolicy · AETNA-CPB-0564	Aug 9, 2023	Covered

Anthem

Anthem policies listing H90.42, with the code’s status in each
Policy	Effective	Status of H90.42
Cochlear Implants and Auditory Brainstem ImplantsClinical Guideline · ANTHEM-CG-SURG-81	Jul 1, 2026	Covered