I63.40 coverage policies: Medicare and commercial payers

43 active Medicare policies list I63.40, 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 I63.40

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 · WPS-J5-L34623

Intraoperative Neurophysiological Testing

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L34623

Intraoperative Neurophysiological Testing

J8 · 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 I63.40

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 I63.40, with the code’s status in each
Policy	Effective	Status of I63.40
Mechanical Embolectomy for Treatment of StrokeClinical Guideline · ANTHEM-CG-SURG-115	Jan 6, 2026	Covered