R63.39 coverage policies: Medicare and commercial payers

26 active Medicare policies list R63.39, 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 R63.39

LCD · FIRST_COAST-L33583

Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9 · Effective Oct 1, 2015

LCD · NGS-J6-L35074

Heavy Metal Testing

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L35074

Heavy Metal Testing

JK · Effective Oct 1, 2015

LCD · FIRST_COAST-L34859

Nerve Conduction Studies and Electromyography

J9 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35081

Nerve Conduction Studies and Electromyography

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35081

Nerve Conduction Studies and Electromyography

JL · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33449

Swallowing Studies for Dysphagia

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33449

Swallowing Studies for Dysphagia

JM · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35350

Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35350

Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

Commercial payer policies listing R63.39

2 policies from 1 payer

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

Anthem

Anthem policies listing R63.39, with the code’s status in each
Policy	Effective	Status of R63.39
Cancer Antigen 125 TestingClinical Guideline · ANTHEM-CG-LAB-32	Oct 1, 2026	Covered
Lingual Frenotomy for Ankyloglossia-Related Feeding DifficultiesClinical Guideline · ANTHEM-CG-SURG-122	Oct 1, 2026	Covered