I76 coverage policies: Medicare and commercial payers

55 active Medicare policies list I76, 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 I76

LCD · PALMETTO-JJ-L40228

Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

JJ · Effective Apr 12, 2026

LCD · PALMETTO-JM-L40228

Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

JM · Effective Apr 12, 2026

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

LCD · NGS-JK-L33633

Magnetic Resonance Angiography (MRA)

JK · Effective Oct 1, 2015

LCD · NOVITAS-JH-L34865

Magnetic Resonance Angiography (MRA)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34865

Magnetic Resonance Angiography (MRA)

JL · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L37373

MRI and CT Scans of the Head and Neck

JE · Effective Oct 8, 2018

LCD · NORIDIAN-JF-L37373

Commercial payer policies listing I76

1 policy from 1 payer

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

Cigna

Cigna policies listing I76, with the code’s status in each
Policy	Effective	Status of I76
Transthoracic Echocardiography in AdultsPayerPolicy · CIGNA-0510	Sep 15, 2026	Covered