I63.139 coverage policies: Medicare and commercial payers

27 active Medicare policies list I63.139, 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 I63.139

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 · WPS-J5-L34636

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

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L34636

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

J8 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35003

Intraoperative Neurophysiological Testing

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35003

Intraoperative Neurophysiological Testing

JL · Effective Oct 1, 2015

LCD · NGS-J6-L33633

Magnetic Resonance Angiography (MRA)

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33633

Magnetic Resonance Angiography (MRA)

JK · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35049

Monitored Anesthesia Care

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35049

Monitored Anesthesia Care

Commercial payer policies listing I63.139

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 I63.139, with the code’s status in each
Policy	Effective	Status of I63.139
Carotid, Vertebral and Intracranial Artery Stent Placement with or without AngioplastyClinical Guideline · ANTHEM-CG-SURG-76	Oct 1, 2026	Covered