I73.89 coverage policies: Medicare and commercial payers

31 active Medicare policies list I73.89, 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 I73.89

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

LCD · NOVITAS-JH-L35092

Diagnostic Abdominal Aortography and Renal Angiography

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35092

Diagnostic Abdominal Aortography and Renal Angiography

JL · 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 · PALMETTO-JJ-L34424

Magnetic Resonance Angiography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34424

Magnetic Resonance Angiography

JM · Effective Oct 1, 2015

LCD · WPS-J5-L35761

Non-Invasive Peripheral Arterial Vascular Studies

Commercial payer policies listing I73.89

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 I73.89, with the code’s status in each
Policy	Effective	Status of I73.89
Hyperbaric Oxygen Therapy (Systemic/Topical)Clinical Guideline · ANTHEM-CG-MED-73	Jul 1, 2026	Covered