I67.1 coverage policies: Medicare and commercial payers

60 active Medicare policies list I67.1, 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 I67.1

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

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 · 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 · PALMETTO-JJ-L34424

Magnetic Resonance Angiography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34424

Magnetic Resonance Angiography

JM · Effective Oct 1, 2015

LCD · NGS-J6-L33633

Magnetic Resonance Angiography (MRA)

J6 · Effective Oct 1, 2015

Commercial payer policies listing I67.1

3 policies from 2 payers

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

Anthem

Anthem policies listing I67.1, with the code’s status in each
Policy	Effective	Status of I67.1
Carotid, Vertebral and Intracranial Artery Stent Placement with or without AngioplastyClinical Guideline · ANTHEM-CG-SURG-76	Oct 1, 2026	Covered
Thyroid TestingClinical Guideline · ANTHEM-CG-LAB-20	Apr 15, 2026	Covered

Ambetter

Ambetter policies listing I67.1, with the code’s status in each
Policy	Effective	Status of I67.1
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered