S04.12XA coverage policies: Medicare and commercial payers

21 active Medicare policies list S04.12XA, and 1 commercial payer policy lists 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 S04.12XA

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 · 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

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 · NOVITAS-JH-L34975

Neurophysiology Evoked Potentials (NEPs)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34975

Neurophysiology Evoked Potentials (NEPs)

JL · Effective Oct 1, 2015

LCD · FIRST_COAST-L33766

Visual Field Examination

Commercial payer policies listing S04.12XA

1 policy from 1 payer

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

Ambetter

Ambetter policies listing S04.12XA, with the code’s status in each
Policy	Effective	Status of S04.12XA
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered

S04.12XA coverage policies: Medicare and commercial payers

Medicare policies listing S04.12XA

CT of the Head

CT of the Head

MRI and CT Scans of the Head and Neck

MRI and CT Scans of the Head and Neck

Nerve Conduction Studies and Electromyography

Nerve Conduction Studies and Electromyography

Nerve Conduction Studies and Electromyography

Neurophysiology Evoked Potentials (NEPs)

Neurophysiology Evoked Potentials (NEPs)

Visual Field Examination

Commercial payer policies listing S04.12XA

Ambetter

S04.12XA coverage policies: Medicare and commercial payers

Medicare policies listing S04.12XA

CT of the Head

CT of the Head

MRI and CT Scans of the Head and Neck

MRI and CT Scans of the Head and Neck

Nerve Conduction Studies and Electromyography

Nerve Conduction Studies and Electromyography

Nerve Conduction Studies and Electromyography

Neurophysiology Evoked Potentials (NEPs)

Neurophysiology Evoked Potentials (NEPs)

Visual Field Examination

Commercial payer policies listing S04.12XA

Ambetter

Visual Fields Testing

Visual Fields Testing

Visual Fields Testing

Billing and Coding: CT of the Head

Billing and Coding: MRI and CT Scans of the Head and Neck

Billing and Coding: Nerve Conduction Studies and Electromyography

Billing and Coding: Nerve Conduction Studies and Electromyography

Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

Billing and Coding: Visual Field Examination

Billing and Coding: Visual Fields Testing

Billing and Coding: Visual Fields Testing