J63.4 coverage policies: Medicare and commercial payers

29 active Medicare policies list J63.4, 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 J63.4

LCD · PALMETTO-JJ-L33459

Computerized Axial Tomography (CT), Thorax

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33459

Computerized Axial Tomography (CT), Thorax

JM · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35049

Monitored Anesthesia Care

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35049

Monitored Anesthesia Care

JL · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35434

Oximetry Services

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35434

Oximetry Services

JL · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33444

Pulmonary Stress Testing

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33444

Pulmonary Stress Testing

JM · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34149

Respiratory Care

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34149

Respiratory Care

JF · Effective Oct 1, 2015

Commercial payer policies listing J63.4

1 policy from 1 payer

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

Ambetter

Ambetter policies listing J63.4, with the code’s status in each
Policy	Effective	Status of J63.4
Pulmonary Function TestingPayerPolicy · AMBETTER-CP-MP-242	Not recorded	Covered