R57.0 coverage policies: Medicare and commercial payers

47 active Medicare policies list R57.0, 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 R57.0

LCD · PALMETTO-JJ-L33457

Cardiac Radionuclide Imaging

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33457

Cardiac Radionuclide Imaging

JM · Effective Oct 1, 2015

LCD · CGS-J15-L33959

Cardiac Catheterization and Coronary Angiography

J15 · Effective Oct 1, 2015

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 · PALMETTO-JJ-L38786

Echocardiography for Myocardial Perfusion

JJ · Effective Feb 7, 2021

LCD · PALMETTO-JM-L38786

Echocardiography for Myocardial Perfusion

JM · Effective Feb 7, 2021

LCD · NORIDIAN-JE-L34315

Electrocardiograms

Commercial payer policies listing R57.0

3 policies from 2 payers

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

Anthem

Anthem policies listing R57.0, with the code’s status in each
Policy	Effective	Status of R57.0
Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts)PayerPolicy · ANTHEM-SURG.00145	Apr 15, 2026	Covered
Outpatient Urine CultureClinical Guideline · ANTHEM-CG-LAB-24	Jan 6, 2026	Covered

Aetna

Aetna policies listing R57.0, with the code’s status in each
Policy	Effective	Status of R57.0
Extracorporeal Membrane Oxygenation (ECMO)PayerPolicy · AETNA-CPB-0546	Aug 10, 2023	Covered