LCD |
Effective Date |
Revision Effective Date |
Title |
CPT Codes Covered in LCD |
L32553
|
10/01/2015
|
11/02/2023
|
Allergy Immunotherapy
|
|
L33943
|
10/01/2015
|
12/07/2023
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B-type Natriuretic Peptide (BNP) Testing
|
|
L33944
|
10/01/2015
|
11/02/2023
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Blepharoplasty
|
|
L33945
|
10/01/2015
|
02/01/2024
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Cerumen (Earwax) Removal
|
|
L33946
|
10/01/2015
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11/02/2023
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Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy
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|
L33947
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10/01/2015
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10/03/2024
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Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
|
|
L33949
|
10/01/2015
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12/07/2023
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Botulinum Toxins
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L33950
|
10/01/2015
|
12/07/2023
|
Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
|
|
L33952
|
10/01/2015
|
12/07/2023
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Cardiac Event Detection
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L33954
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10/01/2015
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01/04/2024
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Cataract Extraction
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|
L33959
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10/01/2015
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11/02/2023
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Cardiac Catheterization and Coronary Angiography
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|
L33960
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10/01/2015
|
02/01/2024
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Cardiovascular Nuclear Medicine
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|
L33996
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10/01/2015
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08/08/2024
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Vitamin D Assay Testing
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L33999
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10/01/2015
|
02/01/2024
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Corneal Pachymetry
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L34005
|
10/01/2015
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02/01/2024
|
Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
|
|
L34008
|
10/01/2015
|
02/01/2024
|
Computerized Corneal Topography
|
|
L34032
|
10/01/2015
|
10/03/2024
|
Debridement Services
|
|
L34037
|
10/01/2015
|
03/07/2024
|
Flow Cytometry
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|
L34045
|
10/01/2015
|
11/02/2023
|
Non-Invasive Vascular Studies
|
|
L34046
|
10/01/2015
|
08/08/2024
|
Speech-Language Pathology
|
|
L34049
|
10/01/2015
|
06/06/2024
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Outpatient Physical and Occupational Therapy Services
|
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L34055
|
10/01/2015
|
10/03/2024
|
Virtual Colonoscopy (CT Colonography)
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L34056
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10/01/2015
|
10/03/2024
|
Urodynamics
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L34061
|
10/01/2015
|
08/08/2024
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Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
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L34062
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10/01/2015
|
02/01/2024
|
Dialysis Access Maintenance
|
|
L34063
|
10/01/2015
|
08/08/2024
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RAST Type Tests
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L34064
|
10/01/2015
|
04/04/2024
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Panretinal (Scatter) Laser Photocoagulation
|
|
L34081
|
10/01/2015
|
03/07/2024
|
Endoscopy by Capsule
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L34082
|
10/01/2015
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10/03/2024
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Varicose Veins of the Lower Extremity, Treatment of
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L34084
|
10/01/2015
|
09/05/2024
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Transcatheter Infusion Therapy
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L34085
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10/01/2015
|
04/04/2024
|
Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
|
|
L34087
|
10/01/2015
|
09/05/2024
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Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based
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|
L34090
|
10/01/2015
|
04/04/2024
|
Laser Ablation of the Prostate
|
|
L34171
|
10/01/2015
|
06/06/2024
|
Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation
|
|
L34175
|
10/01/2015
|
06/06/2024
|
Ophthalmic Angiography (Fluorescein and Indocyanine Green)
|
|
L34181
|
10/01/2015
|
06/06/2024
|
Ophthalmic Biometry for Intraocular Lens Power Calculation
|
|
L34183
|
10/01/2015
|
04/04/2024
|
Psychiatric Inpatient Hospitalization
|
|
L34195
|
10/01/2015
|
05/09/2024
|
Mohs Micrographic Surgery
|
|
L34196
|
10/01/2015
|
04/04/2024
|
Psychiatric Partial Hospitalization Programs
|
|
L34200
|
10/01/2015
|
08/08/2024
|
Removal of Benign Skin Lesions
|
|
L34246
|
10/01/2015
|
08/08/2024
|
Routine Foot Care and Debridement of Nails
|
|
L34337
|
10/01/2015
|
09/05/2024
|
Transesophageal Echocardiography (TEE)
|
|
L34338
|
10/01/2015
|
10/03/2024
|
Transthoracic Echocardiography (TTE)
|
|
L34353
|
10/01/2015
|
06/06/2024
|
Outpatient Psychiatry and Psychology Services
|
|
L34356
|
10/01/2015
|
03/07/2024
|
Erythropoiesis Stimulating Agents (ESA)
|
|
L34393
|
10/01/2015
|
05/09/2024
|
Ocular Photography - External
|
|
L34394
|
10/01/2015
|
10/03/2024
|
Visual Fields Testing
|
|
L34399
|
10/01/2015
|
06/06/2024
|
Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
|
|
L34539
|
10/01/2015
|
04/04/2024
|
Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians
|
|
L34540
|
10/01/2015
|
09/05/2024
|
Stretta Procedure
|
|
L34541
|
10/01/2015
|
10/03/2024
|
Transtelephonic Spirometry
|
|
L35249
|
10/01/2015
|
05/09/2024
|
Nerve Blocks for Peripheral Neuropathy
|
|
L35442
|
10/01/2015
|
07/27/2023
|
MolDX: NRAS Genetic Testing
|
|
L35891
|
10/01/2015
|
04/04/2024
|
Intravenous Immune Globulin
|
|
L35897
|
10/01/2015
|
05/09/2024
|
Nerve Conduction Studies and Electromyography
|
|
L35906
|
10/01/2015
|
04/04/2024
|
Somatosensory Testing
|
|
L35984
|
10/01/2015
|
07/20/2023
|
MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
|
|
L35986
|
10/01/2015
|
03/07/2024
|
Special Histochemical Stains and Immunohistochemical Stains
|
|
L36021
|
10/01/2015
|
08/22/2024
|
MolDX: Molecular Diagnostic Tests (MDT)
|
|
L36029
|
10/05/2015
|
03/07/2024
|
Urine Drug Testing
|
|
L36113
|
10/05/2015
|
08/22/2024
|
MolDX: MGMT Promoter Methylation Analysis
|
|
L36117
|
10/05/2015
|
05/16/2024
|
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
|
|
L36139
|
10/05/2015
|
03/02/2023
|
MolDX: Biomarkers in Cardiovascular Risk Assessment
|
|
L36425
|
02/01/2016
|
02/15/2024
|
MolDX: Breast Cancer Assay: Prosigna®
|
|
L36460
|
02/01/2016
|
01/04/2024
|
Bone Mass Measurement
|
|
L36469
|
02/08/2016
|
06/06/2024
|
Transcranial Magnetic Stimulation (TMS)
|
|
L36485
|
02/15/2016
|
09/19/2024
|
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
|
|
L36494
|
02/01/2016
|
01/04/2024
|
Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
|
|
L36658
|
10/24/2016
|
10/03/2024
|
Proton Beam Therapy
|
|
L36675
|
10/10/2016
|
12/07/2023
|
ProMark® Risk Score
|
|
L36690
|
10/10/2016
|
09/05/2024
|
Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities
|
|
L36902
|
03/06/2017
|
03/07/2024
|
Polysomnography and Other Sleep Studies
|
|
L36906
|
03/06/2017
|
04/04/2024
|
GlycoMark® Testing for Glycemic Control
|
|
L36951
|
03/06/2017
|
09/28/2023
|
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
|
|
L36975
|
03/06/2017
|
02/01/2024
|
Bladder/Urothelial Tumor Markers
|
|
L37126
|
07/10/2017
|
02/01/2024
|
Coenzyme Q10 (CoQ10)
|
|
L37130
|
07/10/2017
|
05/18/2023
|
MolDX: DecisionDx-UM (Uveal Melanoma)
|
|
L37254
|
11/06/2017
|
02/01/2024
|
Chiropractic Services
|
|
L37352
|
11/06/2017
|
02/29/2024
|
MolDX: Prometheus IBD sgi Diagnostic® Policy
|
|
L37356
|
03/06/2018
|
04/11/2024
|
MolDX: EndoPredict Breast Cancer Gene Expression Test
|
|
L37364
|
01/07/2019
|
04/04/2024
|
Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)
|
|
L37575
|
04/01/2019
|
03/07/2024
|
Frequency of Hemodialysis
|
|
L37578
|
03/19/2018
|
11/17/2024
|
Micro-Invasive Glaucoma Surgery (MIGS)
|
|
L37598
|
12/17/2018
|
01/04/2024
|
Cystatin C Measurement
|
|
L37608
|
05/06/2019
|
08/08/2024
|
MDS FISH
|
|
L37790
|
10/01/2018
|
09/05/2024
|
Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions
|
|
L37832
|
04/01/2019
|
11/02/2023
|
MolDX: Breast Cancer Index® (BCI) Gene Expression Test
|
|
L37903
|
05/13/2019
|
06/27/2024
|
MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer
|
|
L37905
|
05/20/2019
|
06/29/2023
|
MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic Test
|
|
L38016
|
06/24/2019
|
05/18/2023
|
MolDX: Melanoma Risk Stratification Molecular Testing
|
|
L38065
|
07/27/2020
|
10/26/2023
|
MolDX: Plasma-Based Genomic Profiling in Solid Tumors
|
|
L38067
|
02/10/2020
|
08/22/2024
|
MolDX: Next-Generation Sequencing for Solid Tumors
|
|
L38070
|
02/10/2020
|
03/28/2024
|
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
|
|
L38111
|
03/30/2020
|
10/26/2023
|
MolDX: Pigmented Lesion Assay
|
|
L38201
|
11/18/2019
|
10/03/2024
|
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
|
|
L38249
|
11/01/2020
|
05/23/2024
|
MolDX: Blood Product Molecular Antigen Typing
|
|
L38268
|
04/01/2020
|
03/07/2024
|
Immune Thrombocytopenia (ITP) Therapy
|
|
L38284
|
07/27/2020
|
10/20/2022
|
MolDX: Predictive Classifiers for Early Stage Non-small Cell Lung Cancer
|
|
L38288
|
06/07/2020
|
04/25/2024
|
MolDX: Repeat Germline Testing
|
|
L38303
|
11/09/2020
|
07/25/2024
|
MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
|
|
L38307
|
04/01/2020
|
03/07/2024
|
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
|
|
L38378
|
04/01/2020
|
04/04/2024
|
Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)
|
|
L38394
|
08/03/2020
|
08/24/2023
|
MolDX: Pharmacogenomics Testing
|
|
L38582
|
06/06/2021
|
07/27/2023
|
MolDX: Molecular Testing for Solid Organ Allograft Rejection
|
|
L38584
|
07/25/2021
|
05/16/2024
|
MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells
|
|
L38586
|
07/18/2021
|
03/21/2024
|
MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
|
|
L38662
|
11/02/2020
|
11/04/2024
|
Implantable Continuous Glucose Monitors (I-CGM)
|
|
L38694
|
11/02/2020
|
06/17/2021
|
Computed Tomography Cerebral Perfusion Analysis (CTP)
|
|
L38771
|
04/25/2021
|
09/05/2024
|
Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
|
|
L38773
|
05/02/2021
|
07/07/2024
|
Facet Joint Interventions for Pain Management
|
|
L38777
|
03/29/2021
|
01/30/2022
|
Colon Capsule Endoscopy (CCE)
|
|
L38822
|
12/26/2021
|
11/02/2023
|
MolDX: Minimal Residual Disease Testing for Cancer
|
|
L38920
|
08/08/2021
|
06/29/2023
|
Off-label Use of Rituximab and Rituximab Biosimilars
|
|
L38992
|
01/30/2022
|
01/12/2023
|
Electroretinography (ERG)
|
|
L38997
|
07/17/2022
|
03/14/2024
|
MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer
|
|
L39015
|
12/05/2021
|
11/09/2023
|
Epidural Steroid Injections for Pain Management
|
|
L39017
|
08/21/2022
|
04/18/2024
|
MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
|
|
L39023
|
01/03/2022
|
07/21/2022
|
Platelet Rich Plasma Injections for Non-Wound Injections
|
|
L39038
|
04/17/2022
|
04/25/2024
|
MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
|
|
L39276
|
06/04/2023
|
02/29/2024
|
MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia
|
|
L39284
|
11/20/2022
|
11/02/2023
|
Prostate Cancer Detection with IsoPSA®
|
|
L39383
|
03/19/2023
|
04/04/2024
|
Sacroiliac Joint Injections and Procedures
|
|
L39389
|
08/06/2023
|
05/16/2024
|
MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma
|
|
L39585
|
08/18/2024
|
|
MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma
|
|