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Currently Active LCDs103
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Currently Active Articles271
Retired Articles14

Currently Active LCDs

All LCDs Laboratory LCDs Radiology LCDs
LCD
Effective
Date
Revision
Effective
Date
Title
CPT Codes Covered in LCD
L34526 10/01/2015 11/01/2019 Surgical Treatment of Obstructive Sleep Apnea (OSA)
L34528 10/01/2015 04/30/2020 Blepharoplasty, Blepharoptosis and Brow Lift
L34536 10/01/2015 11/01/2019 Treatment of Varicose Veins of the Lower Extremities
L34588 10/01/2015 11/01/2019 Trigger Points, Local Injections
L34594 10/01/2015 10/31/2019 Nerve Conduction Studies and Electromyography
L34596 10/01/2015 11/01/2019 Immunizations
L34614 10/01/2015 11/01/2019 Colonoscopy and Sigmoidoscopy-Diagnostic
L34615 10/01/2015 10/31/2019 Visual Fields
L34616 10/01/2015 10/31/2019 Psychiatry and Psychology Services
L34623 10/01/2015 07/30/2020 Intraoperative Neurophysiological Testing
L34624 10/01/2015 11/01/2019 Somatosensory Testing
L34633 10/01/2015 02/09/2020 Erythropoiesis Stimulating Agents (ESAs)
L34635 10/01/2015 01/30/2020 Botulinum Toxin Type A & Type B
L34636 10/01/2015 11/01/2019 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)
L34641 10/01/2015 07/30/2020 Transcranial Magnetic Stimulation (TMS)
L34645 10/01/2015 05/10/2020 Drug Testing
L34646 10/01/2015 10/31/2019 Psychological and Neuropsychological Testing
L34648 10/01/2015 08/27/2020 Bisphosphonate Drug Therapy
L34658 10/01/2015 10/31/2019 Vitamin D Assay Testing
L34659 10/01/2015 11/01/2019 Endoscopic Treatment of GERD
L34698 10/01/2015 10/31/2019 Cosmetic and Reconstructive Surgery
L34760 10/01/2015 11/01/2019 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
L34761 10/01/2015 10/31/2019 Percutaneous Coronary Interventions
L34771 10/01/2015 11/01/2019 Immune Globulins
L35121 10/01/2015 08/27/2020 Coronary Computed Tomography Angiography (CCTA)
L35124 10/01/2015 11/01/2019 Autonomic Function Testing
L35222 10/01/2015 07/30/2020 Nerve Blocks for Peripheral Neuropathy
L35486 10/01/2015 11/01/2019 Pelvic Floor Dysfunction: Anorectal Manometry and EMG
L35490 10/01/2015 07/01/2020 Category III Codes
L35494 10/01/2015 10/31/2019 Mohs Micrographic Surgery
L35498 10/01/2015 10/31/2019 Removal of Benign Skin Lesions
L35751 10/01/2015 12/26/2019 Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
L35753 10/01/2015 12/26/2019 Non-Invasive Cerebrovascular Studies
L35755 10/01/2015 12/26/2019 Non-Invasive Abdominal / Visceral Vascular Studies
L35761 10/01/2015 11/01/2019 Non-Invasive Peripheral Arterial Vascular Studies
L35996 10/01/2015 11/01/2019 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
L35998 10/01/2015 08/27/2020 Non-Coronary Vascular Stents
L36000 12/17/2015 06/25/2020 Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain
L36400 04/16/2016 11/01/2019 MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L36402 03/18/2016 10/31/2019 Allergy Testing
L36408 03/18/2016 05/28/2020 Allergy Immunotherapy
L36521 06/16/2016 11/01/2019 Lumbar Epidural Injections
L36523 06/16/2016 11/01/2019 MolDX: Biomarkers in Cardiovascular Risk Assessment
L36787 02/16/2017 11/01/2019 MolDX: Prolaris™ Prostate Cancer Genomic Assay
L36789 02/16/2017 08/27/2020 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
L36791 02/16/2017 11/01/2019 MolDX: Decipher® Prostate Cancer Classifier Assay
L36793 02/16/2017 12/26/2019 MolDX: Genetic Testing for Lynch Syndrome
L36795 02/16/2017 11/01/2019 MolDX: Molecular RBC Phenotyping
L36797 02/16/2017 11/01/2019 MolDX: NRAS Genetic Testing
L36801 02/16/2017 11/01/2019 MolDX: HLA-B*15:02 Genetic Testing
L36805 02/16/2017 08/27/2020 Lab: Special Histochemical Stains and Immunohistochemical Stains
L36807 02/16/2017 01/01/2020 MolDX: Molecular Diagnostic Tests (MDT)
L36811 02/16/2017 11/01/2019 MolDX: Breast Cancer Assay: Prosigna
L36813 02/16/2017 11/01/2019 MolDX: BRCA1 and BRCA2 Genetic Testing
L36815 02/16/2017 11/01/2019 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
L36839 02/16/2017 11/01/2019 Polysomnography and Other Sleep Studies
L37001 07/17/2017 11/01/2019 MolDX: MGMT Promoter Methylation Analysis
L37003 07/17/2017 11/01/2019 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
L37005 07/17/2017 11/01/2019 MolDX: ConfirmMDx Epigenetic Molecular Assay
L37011 07/17/2017 11/01/2019 MolDX: ProMark Risk Score
L37013 07/17/2017 11/01/2019 MolDX: 4Kscore Assay
L37015 07/17/2017 11/01/2019 Visual Electrophysiology Testing
L37195 09/16/2017 11/01/2019 MolDX: Percepta® Bronchial Genomic Classifier
L37199 09/16/2017 11/01/2019 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
L37205 09/16/2017 11/28/2019 Chemotherapy Drugs and their Adjuncts
L37210 09/16/2017 01/01/2020 MolDX: Decision Dx-UM (Uveal Melanoma)
L37216 09/16/2017 11/28/2019 MolDX: BDX-XL2
L37224 09/16/2017 11/01/2019 MolDX: APC and MUTYH Gene Testing
L37226 09/16/2017 11/01/2019 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
L37228 04/16/2018 02/09/2020 Wound Care
L37537 03/01/2019 07/30/2020 Frequency of Hemodialysis
L37539 03/19/2018 11/01/2019 MolDX: Prometheus IBD sgi Diagnostic Policy
L37663 08/16/2018 11/01/2019 MolDX: EndoPredict® Breast Cancer Gene Expression Test
L37665 08/16/2018 11/01/2019 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test
L37667 08/16/2018 06/25/2020 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
L37764 12/17/2018 11/28/2019 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
L37766 02/16/2019 11/01/2019 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)
L37768 12/17/2018 11/01/2019 MolDX: CYSTATIN C Measurement
L37770 12/17/2018 11/01/2019 MolDX: CORUS® CAD ASSAY
L37772 05/13/2019 11/01/2019 MolDX: MDS FISH
L37911 05/13/2019 11/01/2019 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease
L37913 04/15/2019 11/01/2019 MolDX: Breast Cancer Index™ (BCI) Gene Expression Test
L37915 02/16/2019 11/01/2020 MolDX: Androgen Receptor Variant (AR-V7) Protein Test
L37919 05/13/2019 11/01/2019 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
L37921 04/15/2019 04/30/2020 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer
L37923 06/10/2019 07/01/2019 MolDX: myPath Melanoma Assay
L38018 08/12/2019 11/01/2019 MolDX: DecisionDX-Melanoma
L38158 02/09/2020 04/30/2020 MolDX: Next-Generation Sequencing for Solid Tumors
L38160 12/16/2019 12/16/2019 MolDX: TruGraf® Blood Gene Expression Test
L38166 01/12/2020 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease
L38168 03/15/2020 05/28/2020 MolDX: Plasma-Based Genomic Profiling in Solid Tumors
L38174 04/12/2020 MolDX: Prospera™
L38176 02/09/2020 04/30/2020 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
L38178 04/12/2020 MolDX: Pigmented Lesion Assay
L38211 10/14/2019 11/01/2019 Corneal Hysteresis
L38213 12/16/2019 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
L38429 06/14/2020 MolDX: Repeat Germline Testing
L38431 10/18/2020 MolDX: Minimal Residual Disease Testing for Colorectal Cancer
L38435 07/26/2020 08/06/2020 MolDX: Pharmacogenomics Testing
L38441 10/25/2020 MolDX: Blood Product Molecular Antigen Typing
L38443 06/14/2020 MolDX: Predictive Classifiers for Early Stage Non-small Cell Lung Cancer
L38528 06/14/2020 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
L38686 10/11/2020 Implantable Continuous Glucose Monitors (I-CGM)



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