S14.104S coverage policies: Medicare and commercial payers

25 active Medicare policies list S14.104S, 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 S14.104S

LCD · PALMETTO-JJ-L33461

Implantable Infusion Pump

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33461

Implantable Infusion Pump

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 · NGS-J6-L35098

Nerve Conduction Studies and Electromyography

J6 · Effective Oct 1, 2015

LCD · NGS-JK-L35098

Nerve Conduction Studies and Electromyography

JK · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L36524

Nerve Conduction Studies and Electromyography

JE · Effective Jun 1, 2016

LCD · NORIDIAN-JF-L36524

Nerve Conduction Studies and Electromyography

JF · Effective Jun 1, 2016

LCD · PALMETTO-JJ-L35048

Nerve Conduction Studies and Electromyography

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L35048

Nerve Conduction Studies and Electromyography

Commercial payer policies listing S14.104S

1 policy from 1 payer

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

Anthem

Anthem policies listing S14.104S, with the code’s status in each
Policy	Effective	Status of S14.104S
Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)PayerPolicy · ANTHEM-DME.00022	Apr 15, 2026	Not covered