R79.89 coverage policies: Medicare and commercial payers

31 active Medicare policies list R79.89, 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 R79.89

LCD · FIRST_COAST-L38396

Cardiology Non-emergent Outpatient Stress Testing

J9 · Effective Mar 15, 2020

LCD · NOVITAS-JH-L35083

Cardiology Non-emergent Outpatient Stress Testing

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35083

Cardiology Non-emergent Outpatient Stress Testing

JL · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34415

CT of the Abdomen and Pelvis

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34415

CT of the Abdomen and Pelvis

JM · Effective Oct 1, 2015

LCD · FIRST_COAST-L33583

Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9 · Effective Oct 1, 2015

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 · PALMETTO-JJ-L33431

HbA1c

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33431

HbA1c

Commercial payer policies listing R79.89

3 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 R79.89, with the code’s status in each
Policy	Effective	Status of R79.89
Cancer Antigen 19-9 TestingClinical Guideline · ANTHEM-CG-LAB-35	Oct 1, 2026	Covered
Carcinoembryonic Antigen TestingClinical Guideline · ANTHEM-CG-LAB-33	Oct 1, 2026	Covered
Outpatient Laboratory-based Blood Glucose TestingClinical Guideline · ANTHEM-CG-LAB-30	Jul 1, 2026	Covered