R25.1 coverage policies: Medicare and commercial payers

53 active Medicare policies list R25.1, 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 R25.1

LCD · PALMETTO-JJ-L37641

Continuous Peripheral Nerve Blocks (CPNB)

JJ · Effective Jan 29, 2018

LCD · PALMETTO-JM-L37641

Continuous Peripheral Nerve Blocks (CPNB)

JM · Effective Jan 29, 2018

LCD · PALMETTO-JJ-L34417

CT of the Head

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34417

CT of the Head

JM · Effective Oct 1, 2015

LCD · NGS-J6-L33399

EEG â Ambulatory Monitoring

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33399

EEG â Ambulatory Monitoring

JK · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L39400

Magnesium

JJ · Effective Jan 22, 2023

LCD · PALMETTO-JM-L39400

Magnesium

JM · Effective Jan 22, 2023

LCD · NORIDIAN-JE-L37373

MRI and CT Scans of the Head and Neck

JE · Effective Oct 8, 2018

LCD · NORIDIAN-JF-L37373

MRI and CT Scans of the Head and Neck

JF · Effective Oct 8, 2018

Commercial payer policies listing R25.1

2 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 R25.1, with the code’s status in each
Policy	Effective	Status of R25.1
Actigraphy and AccelerometryPayerPolicy · AETNA-CPB-0710	Oct 3, 2023	Covered

Cigna

Cigna policies listing R25.1, with the code’s status in each
Policy	Effective	Status of R25.1
ElectroencephalographyPayerPolicy · CIGNA-0521	Feb 15, 2026	Covered