I95.3 coverage policies: Medicare and commercial payers

28 active Medicare policies list I95.3, 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 I95.3

LCD · NOVITAS-JH-L34914

Assays for Vitamins and Metabolic Function

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34914

Assays for Vitamins and Metabolic Function

JL · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34315

Electrocardiograms

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34315

Electrocardiograms

JF · Effective Oct 1, 2015

LCD · CGS-J15-L37575

Frequency of Hemodialysis

J15 · Effective Apr 1, 2019

LCD · FIRST_COAST-L37564

Frequency of Hemodialysis

J9 · Effective Mar 1, 2019

LCD · NGS-J6-L37475

Frequency of Hemodialysis

J6 · Effective Mar 1, 2019

LCD · NGS-JK-L37475

Frequency of Hemodialysis

JK · Effective Mar 1, 2019

LCD · NORIDIAN-JE-L37502

Frequency of Hemodialysis

JE · Effective Feb 18, 2019

LCD · NORIDIAN-JF-L37502

Frequency of Hemodialysis

JF · Effective Feb 18, 2019

Commercial payer policies listing I95.3

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 I95.3, with the code’s status in each
Policy	Effective	Status of I95.3
Transthoracic Echocardiography in AdultsPayerPolicy · CIGNA-0510	Sep 15, 2026	Covered