R47.89 coverage policies: Medicare and commercial payers

72 active Medicare policies list R47.89, 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 R47.89

LCD · NGS-J6-L38667

Computed Tomography Cerebral Perfusion Analysis (CTP)

J6 · Effective Nov 1, 2020

LCD · NGS-JK-L38667

Computed Tomography Cerebral Perfusion Analysis (CTP)

JK · Effective Nov 1, 2020

LCD · PALMETTO-JJ-L38769

Computed Tomography Cerebral Perfusion Analysis (CTP)

JJ · Effective Feb 7, 2021

LCD · PALMETTO-JM-L38769

Computed Tomography Cerebral Perfusion Analysis (CTP)

JM · Effective Feb 7, 2021

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 · FIRST_COAST-L33674

Duplex Scanning

J9 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34425

Magnetic Resonance Imaging of the Head and Neck

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34425

Magnetic Resonance Imaging of the Head and Neck

JM · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L37373

MRI and CT Scans of the Head and Neck

Commercial payer policies listing R47.89

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 R47.89, with the code’s status in each
Policy	Effective	Status of R47.89
Voice TherapyPayerPolicy · AETNA-CPB-0646	Sep 13, 2023	Covered

Cigna

Cigna policies listing R47.89, with the code’s status in each
Policy	Effective	Status of R47.89
Electrodiagnostic Testing (EMG/NCV)PayerPolicy · CIGNA-CPG129	Sep 15, 2026	Covered