R15.0 coverage policies: Medicare and commercial payers

33 active Medicare policies list R15.0, and 10 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 R15.0

LCD · FIRST_COAST-L33583

Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9 · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34220

Lumbar MRI

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34220

Lumbar MRI

JF · Effective Oct 1, 2015

LCD · CGS-J15-L35897

Nerve Conduction Studies and Electromyography

J15 · Effective Oct 1, 2015

LCD · FIRST_COAST-L34859

Nerve Conduction Studies and Electromyography

J9 · Effective Oct 1, 2015

LCD · NGS-J6-L35098

Nerve Conduction Studies and Electromyography

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L35098

Nerve Conduction Studies and Electromyography

JK · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L36524

Nerve Conduction Studies and Electromyography

JE · Effective Jun 1, 2016

LCD · NORIDIAN-JF-L36524

Nerve Conduction Studies and Electromyography

JF · Effective Jun 1, 2016

LCD · NOVITAS-JH-L35081

Nerve Conduction Studies and Electromyography

Commercial payer policies listing R15.0

10 policies from 2 payers

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

Aetna

Aetna policies listing R15.0, with the code’s status in each
Policy	Effective	Status of R15.0
Botulinum ToxinPayerPolicy · AETNA-CPB-0113	Jan 1, 2024	Covered
Bowel Management DevicesPayerPolicy · AETNA-CPB-0522	Dec 5, 2023	Covered
Fecal IncontinencePayerPolicy · AETNA-CPB-0611	Aug 31, 2023	Covered
Gastrointestinal Function: Selected TestsPayerPolicy · AETNA-CPB-0396	Aug 30, 2023	Covered
Gastrointestinal ManometryPayerPolicy · AETNA-CPB-0616	Sep 11, 2023	Covered
Upper Gastrointestinal Endoscopy and Gastrointestinal BiopsyPayerPolicy · AETNA-CPB-0738	Oct 4, 2023	Covered

Policy	Effective	Status of R15.0
Biofeedback and NeurofeedbackClinical Guideline · ANTHEM-CG-MED-97	Jul 1, 2026	Covered
Outpatient Laboratory-based Blood Glucose TestingClinical Guideline · ANTHEM-CG-LAB-30	Jul 1, 2026	Covered
Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal IncontinenceClinical Guideline · ANTHEM-CG-SURG-95	Oct 1, 2026	Covered
Transrectal UltrasonographyClinical Guideline · ANTHEM-CG-RAD-28	Apr 15, 2026	Covered