I25.84 coverage policies: Medicare and commercial payers

55 active Medicare policies list I25.84, 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 I25.84

LCD · FIRST_COAST-L39492

Ambulatory Electrocardiograph (AECG) Monitoring

J9 · Effective Jun 11, 2023

LCD · NOVITAS-JH-L39490

Ambulatory Electrocardiograph (AECG) Monitoring

JH · Effective Jun 11, 2023

LCD · NOVITAS-JL-L39490

Ambulatory Electrocardiograph (AECG) Monitoring

JL · Effective Jun 11, 2023

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

Commercial payer policies listing I25.84

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 I25.84, with the code’s status in each
Policy	Effective	Status of I25.84
Transthoracic Echocardiography in AdultsPayerPolicy · CIGNA-0510	Sep 15, 2026	Covered