I97.130 coverage policies: Medicare and commercial payers

39 active Medicare policies list I97.130, 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 I97.130

LCD · PALMETTO-JJ-L33457

Cardiac Radionuclide Imaging

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33457

Cardiac Radionuclide Imaging

JM · Effective Oct 1, 2015

LCD · CGS-J15-L33959

Cardiac Catheterization and Coronary Angiography

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L33557

Cardiac Catheterization and Coronary Angiography

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33557

Cardiac Catheterization and Coronary Angiography

JK · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34324

Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34324

Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

JF · 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 · PALMETTO-JJ-L38786

Commercial payer policies listing I97.130

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 I97.130, with the code’s status in each
Policy	Effective	Status of I97.130
Ultrafiltration in Decompensated Heart FailurePayerPolicy · ANTHEM-MED.00102	Apr 15, 2026	Not covered