I26.01 coverage policies: Medicare and commercial payers

70 active Medicare policies list I26.01, and 3 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 I26.01

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 · PALMETTO-JJ-L33423

Cardiac Computed Tomography & Angiography (CCTA)

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33423

Cardiac Computed Tomography & Angiography (CCTA)

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33459

Computerized Axial Tomography (CT), Thorax

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33459

Computerized Axial Tomography (CT), Thorax

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L37379

Echocardiography

Commercial payer policies listing I26.01

3 policies from 2 payers

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

Ambetter

Ambetter policies listing I26.01, with the code’s status in each
Policy	Effective	Status of I26.01
Concert Genetic Testing: Toxicology and Pharmacogenetics Version BPayerPolicy · AMBETTER-CONCERT-GENETIC-TESTING-TOXICOLOGY-AND-PHARMACOGENETICS-VERSION-B	Not recorded	Referenced
Pulmonary Function TestingPayerPolicy · AMBETTER-CP-MP-242	Not recorded	Covered

Anthem

Anthem policies listing I26.01, with the code’s status in each
Policy	Effective	Status of I26.01
Venous Angioplasty with or without Stent Placement or Venous Stenting AloneClinical Guideline · ANTHEM-CG-SURG-106	Apr 15, 2026	Covered