I25.769 coverage policies: Medicare and commercial payers

58 active Medicare policies list I25.769, 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 I25.769

LCD · WPS-J5-L39913

Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

J5 · Effective Nov 24, 2024

LCD · WPS-J8-L39913

Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

J8 · Effective Nov 24, 2024

LCD · PALMETTO-JJ-L33457

Cardiac Radionuclide Imaging

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33457

Cardiac Radionuclide Imaging

JM · Effective Oct 1, 2015

LCD · CGS-J15-L33959

Cardiac Catheterization and Coronary Angiography

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L33557

Cardiac Catheterization and Coronary Angiography

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33557

Cardiac Catheterization and Coronary Angiography

JK · Effective Oct 1, 2015

LCD · CGS-J15-L33947

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33423

Cardiac Computed Tomography & Angiography (CCTA)

JJ · Effective Oct 1, 2015

Commercial payer policies listing I25.769

1 policy from 1 payer

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

Anthem

Anthem policies listing I25.769, with the code’s status in each
Policy	Effective	Status of I25.769
Enhanced External Counterpulsation in the Outpatient SettingClinical Guideline · ANTHEM-CG-MED-86	Jan 6, 2026	Covered