J94.0 coverage policies: Medicare and commercial payers

21 active Medicare policies list J94.0, and 2 commercial payer policies list 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 J94.0

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 · NORIDIAN-JE-L34315

Electrocardiograms

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34315

Electrocardiograms

JF · Effective Oct 1, 2015

LCD · CGS-J15-L34037

Flow Cytometry

J15 · 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 · NORIDIAN-JE-L34149

Respiratory Care

JE · Effective Oct 1, 2015

Commercial payer policies listing J94.0

2 policies from 2 payers

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

Ambetter

Ambetter policies listing J94.0, with the code’s status in each
Policy	Effective	Status of J94.0
Pulmonary Function TestingPayerPolicy · AMBETTER-CP-MP-242	Not recorded	Covered

Cigna

Cigna policies listing J94.0, with the code’s status in each
Policy	Effective	Status of J94.0
Flow CytometryPayerPolicy · CIGNA-0538	Sep 15, 2026	Covered