I87.1 coverage policies: Medicare and commercial payers

40 active Medicare policies list I87.1, 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 I87.1

LCD · CGS-J15-L34062

Dialysis Access Maintenance

J15 · 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 · FIRST_COAST-L38231

Endovenous Stenting

J9 · Effective Dec 30, 2019

LCD · NOVITAS-JH-L37893

Endovenous Stenting

JH · Effective May 20, 2019

LCD · NOVITAS-JL-L37893

Endovenous Stenting

JL · Effective May 20, 2019

LCD · WPS-J5-L35998

Non-Coronary Vascular Stents

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L35998

Non-Coronary Vascular Stents

J8 · Effective Oct 1, 2015

LCD · WPS-J5-L35751

Commercial payer policies listing I87.1

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 I87.1, with the code’s status in each
Policy	Effective	Status of I87.1
Venous Angioplasty with or without Stent Placement or Venous Stenting AloneClinical Guideline · ANTHEM-CG-SURG-106	Apr 15, 2026	Covered