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Currently Active LCDs130
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Currently Active LCDs

All LCDs Laboratory LCDs Radiology LCDs
LCD
Effective
Date
Revision
Effective
Date
Title
CPT Codes Covered in LCD
L32553 10/01/2015 11/07/2019 Allergy Immunotherapy
L33943 10/01/2015 11/28/2019 B-type Natriuretic Peptide (BNP) Testing
L33944 10/01/2015 11/07/2019 Blepharoplasty
L33945 10/01/2015 09/19/2019 Cerumen (Earwax) Removal
L33946 10/01/2015 11/07/2019 Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy
L33947 10/01/2015 09/19/2019 Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
L33949 10/01/2015 11/28/2019 Botulinum Toxins
L33950 10/01/2015 11/28/2019 Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
L33952 10/01/2015 09/19/2019 Cardiac Event Detection
L33954 10/01/2015 12/26/2019 Cataract Extraction
L33959 10/01/2015 11/07/2019 Cardiac Catheterization and Coronary Angiography
L33960 10/01/2015 09/19/2019 Cardiovascular Nuclear Medicine
L33996 10/01/2015 11/28/2019 Vitamin D Assay Testing
L33999 10/01/2015 09/19/2019 Corneal Pachymetry
L34005 10/01/2015 09/19/2019 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
L34008 10/01/2015 09/19/2019 Computerized Corneal Topography
L34032 10/01/2015 09/12/2019 Debridement Services
L34037 10/01/2015 10/31/2019 Flow Cytometry
L34045 10/01/2015 11/28/2019 Non-Invasive Vascular Studies
L34046 10/01/2015 09/26/2019 Speech-Language Pathology
L34049 10/01/2015 11/14/2019 Outpatient Physical and Occupational Therapy Services
L34055 10/01/2015 09/26/2019 Virtual Colonoscopy (CT Colonography)
L34056 10/01/2015 09/26/2019 Urodynamics
L34061 10/01/2015 10/03/2019 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
L34062 10/01/2015 09/19/2019 Dialysis Access Maintenance
L34063 10/01/2015 12/05/2019 RAST Type Tests
L34064 10/01/2015 10/03/2019 Panretinal (Scatter) Laser Photocoagulation
L34081 10/01/2015 09/19/2019 Endoscopy by Capsule
L34082 10/01/2015 09/26/2019 Varicose Veins of the Lower Extremity, Treatment of
L34084 10/01/2015 12/05/2019 Transcatheter Infusion Therapy
L34085 10/01/2015 10/01/2016 Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
L34087 10/01/2015 09/26/2019 Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based
L34089 10/01/2015 09/19/2019 Human Papillomavirus (HPV) Testing
L34090 10/01/2015 09/19/2019 Laser Ablation of the Prostate
L34171 10/01/2015 09/26/2019 Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation
L34175 10/01/2015 10/31/2019 Ophthalmic Angiography (Fluorescein and Indocyanine Green)
L34181 10/01/2015 12/05/2019 Ophthalmic Biometry for Intraocular Lens Power Calculation
L34183 10/01/2015 09/26/2019 Psychiatric Inpatient Hospitalization
L34195 10/01/2015 08/08/2019 Mohs Micrographic Surgery
L34196 10/01/2015 11/07/2019 Psychiatric Partial Hospitalization Programs
L34200 10/01/2015 09/26/2019 Removal of Benign Skin Lesions
L34246 10/01/2015 11/28/2019 Routine Foot Care and Debridement of Nails
L34337 10/01/2015 09/26/2019 Transesophageal Echocardiography (TEE)
L34338 10/01/2015 09/26/2019 Transthoracic Echocardiography (TTE)
L34353 10/01/2015 11/07/2019 Outpatient Psychiatry and Psychology Services
L34356 10/01/2015 10/03/2019 Erythropoiesis Stimulating Agents (ESA)
L34393 10/01/2015 10/31/2019 Ocular Photography - External
L34394 10/01/2015 09/26/2019 Visual Fields Testing
L34399 10/01/2015 12/05/2019 Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
L34539 10/01/2015 11/28/2019 Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians
L34540 10/01/2015 09/26/2019 Stretta Procedure
L34541 10/01/2015 09/26/2019 Transtelephonic Spirometry
L34807 10/01/2015 12/26/2019 Lumbar Epidural Steroid Injections (ESI)
L34832 10/01/2015 12/26/2019 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
L35249 10/01/2015 10/31/2019 Nerve Blocks for Peripheral Neuropathy
L35332 10/01/2015 09/23/2019 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
L35349 10/01/2015 12/05/2019 MolDX: Genetic Testing for Lynch Syndrome
L35442 10/01/2015 11/28/2019 MolDX: NRAS Genetic Testing
L35443 10/01/2015 11/28/2019 MolDX: GeneSight ® Assay for Refractory Depression
L35891 10/01/2015 09/19/2019 Intravenous Immune Globulin
L35897 10/01/2015 10/24/2019 Nerve Conduction Studies and Electromyography
L35906 10/01/2015 09/26/2019 Somatosensory Testing
L35984 10/01/2015 10/31/2019 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L35986 10/01/2015 10/31/2019 Special Histochemical Stains and Immunohistochemical Stains
L36002 10/05/2015 11/07/2019 MolDX: Prolaris™ Prostate Cancer Genomic Assay
L36006 10/05/2015 11/07/2019 MolDX: ConfirmMDx Epigenetic Molecular Assay
L36011 10/05/2015 11/07/2019 MolDX: Molecular RBC Phenotyping
L36021 10/01/2015 12/19/2019 MolDX: Molecular Diagnostic Tests (MDT)
L36029 10/05/2015 11/21/2019 Controlled Substance Monitoring and Drugs of Abuse Testing
L36048 10/05/2015 11/07/2019 MolDX: HLA-B*15:02 Genetic Testing
L36113 10/05/2015 06/04/2020 MolDX: MGMT Promoter Methylation Analysis
L36117 10/05/2015 12/19/2019 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
L36139 10/05/2015 11/14/2019 MolDX: Biomarkers in Cardiovascular Risk Assessment
L36206 10/05/2015 11/14/2019 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
L36425 02/01/2016 09/23/2019 MolDX: Breast Cancer Assay: Prosigna
L36456 02/15/2016 01/09/2020 MolDX: BRCA1 and BRCA2 Genetic Testing
L36460 02/01/2016 12/26/2019 Bone Mass Measurement
L36469 02/08/2016 12/26/2019 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder
L36485 02/15/2016 12/26/2019 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
L36494 02/01/2016 12/26/2019 Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
L36656 10/10/2016 11/14/2019 MolDX: Decipher® Prostate Cancer Classifier Assay
L36658 10/24/2016 09/26/2019 Proton Beam Therapy
L36675 10/10/2016 11/28/2019 MolDX- CDD: ProMark Risk Score
L36690 10/10/2016 10/31/2019 Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities
L36902 03/06/2017 09/26/2019 Polysomnography and Other Sleep Studies
L36906 03/06/2017 10/31/2019 GlycoMark Testing for Glycemic Control
L36908 03/13/2017 11/28/2019 MolDX: Percepta® Bronchial Genomic Classifier
L36910 03/13/2017 11/28/2019 MolDX: APC and MUTYH Gene Testing
L36951 03/06/2017 11/28/2019 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
L36973 03/06/2017 11/07/2019 MolDX: Circulating Tumor Cell Marker Assays
L36975 03/06/2017 10/31/2019 Bladder/Urothelial Tumor Markers
L36979 03/13/2017 10/31/2019 MolDX: 4Kscore Assay
L37126 07/10/2017 09/19/2019 Coenzyme Q10 (CoQ10)
L37130 07/10/2017 10/31/2019 MolDX: DecisionDx-UM (Uveal Melanoma)
L37134 07/10/2017 06/04/2020 MolDX: BDX-XL2
L37142 07/10/2017 06/04/2020 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
L37254 11/06/2017 09/19/2019 Chiropractic Services
L37348 12/03/2018 11/28/2019 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
L37352 11/06/2017 11/14/2019 MolDX: Prometheus IBD sgi Diagnostic Policy
L37354 03/06/2018 11/14/2019 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
L37356 03/06/2018 11/14/2019 MolDX: EndoPredict Breast Cancer Gene Expression Test
L37362 03/06/2018 10/31/2019 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test
L37364 01/07/2019 11/28/2019 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)
L37575 04/01/2019 10/01/2019 Frequency of Hemodialysis
L37578 03/19/2018 12/30/2019 Micro-Invasive Glaucoma Surgery (MIGS)
L37598 12/17/2018 11/28/2019 MolDX: Cystatin C Measurement
L37608 05/06/2019 11/07/2019 MolDX: MDS FISH
L37787 11/12/2018 09/19/2019 MolDX: Corus® CAD Assay
L37790 10/01/2018 09/19/2019 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor
L37832 04/01/2019 10/31/2019 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test
L37834 04/29/2019 01/09/2020 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease
L37836 03/25/2019 11/21/2019 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)
L37903 05/13/2019 03/05/2020 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer
L37905 05/20/2019 11/07/2019 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
L37907 06/03/2019 10/31/2019 MolDX: myPath Melanoma Assay
L38016 06/24/2019 10/03/2019 MolDX: DecisionDx-Melanoma
L38053 12/30/2019 MolDX: TruGraf Blood Gene Expression Test
L38059 03/10/2020 MolDX: Prospera
L38065 07/27/2020 MolDX: Plasma-Based Genomic Profiling in Solid Tumors
L38067 02/10/2020 03/05/2020 MolDX: Next-Generation Sequencing for Solid Tumors
L38070 02/10/2020 03/05/2020 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
L38077 04/06/2020 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease
L38111 03/30/2020 MolDX: Pigmented Lesion Assay
L38201 11/18/2019 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
L38268 04/01/2020 Immune Thrombocytopenia (ITP) Therapy
L38284 07/27/2020 MolDX: Predictive Classifiers for Early Stage Non-small Cell Lung Cancer
L38288 06/07/2020 MolDX: Repeat Germline Testing
L38307 04/01/2020 04/01/2020 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
L38378 04/01/2020 09/01/2020 Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)
L38394 08/03/2020 MolDX: Pharmacogenomics Testing



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