Q87.42 coverage policies: Medicare and commercial payers

27 active Medicare policies list Q87.42, and 3 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 Q87.42

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 · PALMETTO-JJ-L37379

Echocardiography

JJ · Effective Sep 18, 2017

LCD · PALMETTO-JM-L37379

Echocardiography

JM · Effective Sep 18, 2017

LCD · NGS-J6-L33633

Magnetic Resonance Angiography (MRA)

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33633

Magnetic Resonance Angiography (MRA)

JK · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33467

Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33467

Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

JM · Effective Oct 1, 2015

LCD · CGS-J15-L34399

Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15 · Effective Oct 1, 2015

LCD · NGS-J6-L33567

Commercial payer policies listing Q87.42

3 policies from 1 payer

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

Ambetter

Ambetter policies listing Q87.42, with the code’s status in each
Policy	Effective	Status of Q87.42
Extended OphthalmoscopyPayerPolicy · AMBETTER-CP-VP-26	Not recorded	Covered
Fundus PhotographyPayerPolicy · AMBETTER-CP-VP-29	Not recorded	Covered
Medically Necessary Optical HardwarePayerPolicy · AMBETTER-CP-VP-06	Not recorded	Covered