Insurance Coverage Providers

BlueCross BlueShield – Alabama

BCBS Alabama

Carelon

Cigna

Evicore

L33423 (Palmetto GBA, LCC)

Medicare LCD – Alabama

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Alaska

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Alaska

Premera

Carelon

Cigna

Evicore

Medicare LCD – Alaska

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Arizona

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Arizona

BCBS Arizona

Carelon

Cigna

Evicore

Medicare LCD – Arizona

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Arkansas

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Arkansas

BCBS Arkansas

Carelon

Cigna

Evicore

Medicare LCD – Arkansas

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

California

Coverage Providers

Policy Links

AETNA

BlueCross Anthem – California

BlueShield – California

Blue Shield CA

Carelon

Cigna

Evicore

Medicare LCD – California

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Colorado

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Colorado

Carelon

Cigna

Evicore

Medicare LCD – Colorado

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Connecticut

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Connecticut

Carelon

Cigna

Evicore

Medicare LCD – Connecticut

NIA Evolent

Priority Health

United Healthcare Clinical Indications

United Healthcare – Connecticut

Delaware

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Delaware

BCBS Highmark

Carelon

Cigna

Evicore

Medicare LCD – Delaware

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

District of Columbia

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – District of Columbia

BCBS CareFirst

Carelon

Cigna

Evicore

Medicare LCD – District of Columbia

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Florida

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Florida

BCBS Florida

Carelon

Cigna

Evicore

L33282 (First Coast Service Options)

Medicare LCD – Florida

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Georgia

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Georgia

BCBS Georgia

Carelon

Cigna

Evicore

Medicare LCD – Georgia

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Hawaii

Coverage Providers

Policy Links

AETNA

Hawaii Medical Services Association

BlueCross BlueShield – Hawaii

Carelon

Cigna

Evicore

Medicare LCD – Hawaii

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Idaho

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Idaho

Idaho BCBS

BlueCross BlueShield – Idaho

Carelon

Cigna

Evicore

Medicare LCD – Idaho

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Illinois

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Illinois

BCBS Illinois

Carelon

Cigna

Evicore

Medicare LCD – Illinois

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Indiana

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Indiana

Carelon

Cigna

Evicore

Medicare LCD – Indiana

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Iowa

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Iowa

BCBS Wellmark

Carelon

Cigna

Evicore

Medicare LCD – Iowa

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Kansas

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Kansas

BCBS Kansas

Carelon

Cigna

Evicore

Medicare LCD – Kansas

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Kentucky

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Kentucky

Carelon

Cigna

Evicore

L33947 (CGS Administrators)

Medicare LCD – Kentucky

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Louisiana

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Louisiana

BCBS Louisiana

Carelon

Cigna

Evicore

Medicare LCD – Louisiana

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Maine

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Maine

Carelon

Cigna

Evicore

Medicare LCD – Maine

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Maryland

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Maryland

BCBS CareFirst

Carelon

Cigna

Evicore

Medicare LCD – Maryland

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Massachusetts

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Massachusetts

BCBS Massachusetts

Carelon

Cigna

Evicore

Medicare LCD – Massachusetts

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Michigan

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Michigan

BCBS Michigan

Carelon

Cigna

Evicore

Medicare LCD – Michigan

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Minnesota

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Minnesota

BCBS Minnesota

Carelon

Cigna

Evicore

Medicare LCD – Minnesota

NIA Evolent – Minnesota

Priority Health

United Healthcare

United Healthcare Clinical Indications

Mississippi

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Mississippi

BCBS Mississippi

Carelon

Cigna

Evicore

Medicare LCD – Mississippi

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Missouri

Coverage Providers

Policy Links

AETNA

Carelon

Cigna

Evicore

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Montana

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Montana

BCBS Montana

Carelon

Cigna

Evicore

Medicare LCD – Montana

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Nebraska

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Nebraska

BCBS Nebraska

Carelon

Cigna

Evicore

Medicare LCD – Nebraska

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Nevada

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Nevada

Carelon

Cigna

Evicore

Medicare LCD – Nevada

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

New Hampshire

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – New Hampshire

Carelon

Cigna

Evicore

Medicare LCD – New Hampshire

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

New Jersey

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – New Jersey

BCBS Horizon

Carelon

Cigna

Evicore

Medicare LCD – New Jersey

NIA Evolent

Priority Health

United Healthcare Clinical Indications

United Healthcare – New Jersey

New Mexico

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – New Mexico

BCBS New Mexico

Carelon

Cigna

Evicore

Medicare LCD – New Mexico

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

New York

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – New York

BCBS Empire

BlueCross BlueShield – New York

BCBS Western

BlueCross BlueShield – New York

Excellus BCBS

Carelon

Cigna

Evicore

Medicare LCD – New York

NIA Evolent

Priority Health

North Carolina

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – North Carolina

BCBS North Carolina

Carelon

Cigna

Evicore

Medicare LCD – North Carolina

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

North Dakota

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – North Dakota

BCBS North Dakota

Carelon

Cigna

Evicore

Medicare LCD – North Dakota

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Ohio

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Ohio

Carelon

Cigna

Evicore

L33947 (CGS Administrators)

Medicare LCD – Ohio

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Oklahoma

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Oklahoma

BCBS Oklahoma

Carelon

Cigna

Evicore

Medicare LCD – Oklahoma

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Oregon

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Oregon

Carelon

Cigna

Evicore

Medicare LCD – Oregon

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Pennsylvania

Coverage Providers

Policy Links

AETNA

Pennsylvania Capital Blue Cross

BlueCross BlueShield – Pennsylvania

BCBS Highmark

BlueCross BlueShield – Pennsylvania

BlueCross BlueShield – Pennsylvania

Independence (Philadelphia)

Carelon

Cigna

Evicore

Medicare LCD – Pennsylvania

NIA Evolent

Priority Health

Rhode Island

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Rhode Island

BCBS Rhode Island

Carelon

Cigna

Evicore

Medicare LCD – Rhode Island

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

South Carolina

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – South Carolina

BCBS South Carolina

Carelon

Cigna

Evicore

Medicare LCD – South Carolina

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

South Dakota

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – South Dakota

BCBS Wellmark

Carelon

Cigna

Evicore

Medicare LCD – South Dakota

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Tennessee

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Tennessee

BCBS Tennessee

Carelon

Cigna

Evicore

Medicare LCD – Tennessee

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Texas

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Texas

BCBS Texas

Carelon

Cigna

Evicore

Medicare LCD – Texas

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Utah

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Utah

Carelon

Cigna

Evicore

Medicare LCD – Utah

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Vermont

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Vermont

BCBS Vermont

Carelon

Cigna

Evicore

Medicare LCD – Vermont

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Virginia

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Virginia

BlueCross BlueShield – Virginia

BCBS CareFirst

Carelon

Cigna

Evicore

Medicare LCD – Virginia

Medicare LCD – Virginia

NIA Evolent

Priority Health

Washington

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Washington

BCBS Premera

BlueCross BlueShield – Washington

Carelon

Cigna

Evicore

Medicare LCD – Washington

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

West Virginia

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – West Virginia

BCBS Highmark

BlueCross BlueShield – Wisconsin

Carelon

Cigna

Evicore

Medicare LCD – West Virginia

Medicare LCD – Wisconsin

NIA Evolent

Priority Health

Wisconsin

Coverage Providers

Policy Links

AETNA

Carelon

Cigna

Evicore

NIA Evolent

Priority Health

United Healthcare

United Healthcare Clinical Indications

Wyoming

Coverage Providers

Policy Links

AETNA

BlueCross BlueShield – Wyoming

BCBS Wyoming

Carelon

Cigna

Evicore

Medicare LCD – Wyoming

NIA Evolent

Priority Health