I45.4 coverage policies: Medicare and commercial payers

29 active Medicare policies list I45.4, 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 I45.4

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 · NORIDIAN-JE-L34324

Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34324

Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

JF · Effective Oct 1, 2015

LCD · NGS-J6-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33394

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

JK · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34315

Electrocardiograms

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34315

Electrocardiograms

JF · Effective Oct 1, 2015

LCD · WPS-J5-L34636

Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J5 · Effective Oct 1, 2015

Commercial payer policies listing I45.4

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 I45.4, with the code’s status in each
Policy	Effective	Status of I45.4
Transthoracic Echocardiography in AdultsPayerPolicy · CIGNA-0510	Sep 15, 2026	Covered