I63.133 coverage policies: Medicare and commercial payers

93 active Medicare policies list I63.133, 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 I63.133

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

LCD · PALMETTO-JJ-L34410

B-type Natriuretic Peptide (BNP) Testing

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34410

B-type Natriuretic Peptide (BNP) Testing

JM · Effective Oct 1, 2015

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 · PALMETTO-JJ-L37379

Echocardiography

JJ · Effective Sep 18, 2017

LCD · PALMETTO-JM-L37379

Echocardiography

JM · Effective Sep 18, 2017

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 I63.133

1 policy from 1 payer

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

Ambetter

Ambetter policies listing I63.133, with the code’s status in each
Policy	Effective	Status of I63.133
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered