S06.5X4A coverage policies: Medicare and commercial payers

36 active Medicare policies list S06.5X4A, 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 S06.5X4A

LCD · FIRST_COAST-L36767

Aortography and peripheral angiography

J9 · Effective Oct 31, 2016

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 · NGS-J6-L33633

Magnetic Resonance Angiography (MRA)

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L33633

Magnetic Resonance Angiography (MRA)

JK · Effective Oct 1, 2015

LCD · NOVITAS-JH-L34865

Magnetic Resonance Angiography (MRA)

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L34865

Magnetic Resonance Angiography (MRA)

JL · 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 · NOVITAS-JH-L34975

Neurophysiology Evoked Potentials (NEPs)

JH · Effective Oct 1, 2015

Commercial payer policies listing S06.5X4A

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 S06.5X4A, with the code’s status in each
Policy	Effective	Status of S06.5X4A
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered