| LCD |
Effective
Date |
Revision
Effective
Date |
Title |
CPT Codes Covered in LCD |
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L32553
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10/01/2015
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10/27/2022
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Allergy Immunotherapy
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L33943
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10/01/2015
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12/01/2022
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B-type Natriuretic Peptide (BNP) Testing
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L33944
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10/01/2015
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10/27/2022
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Blepharoplasty
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L33945
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10/01/2015
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02/03/2022
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Cerumen (Earwax) Removal
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L33946
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10/01/2015
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10/27/2022
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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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10/06/2022
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Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
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L33949
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10/01/2015
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11/25/2021
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Botulinum Toxins
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L33950
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10/01/2015
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12/01/2022
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Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
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L33952
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10/01/2015
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12/01/2022
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Cardiac Event Detection
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L33954
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10/01/2015
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01/06/2022
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Cataract Extraction
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L33959
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10/01/2015
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10/27/2022
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Cardiac Catheterization and Coronary Angiography
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L33960
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10/01/2015
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02/03/2022
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Cardiovascular Nuclear Medicine
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L33996
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10/01/2015
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08/04/2022
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Vitamin D Assay Testing
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L33999
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10/01/2015
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02/03/2022
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Corneal Pachymetry
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L34005
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10/01/2015
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02/03/2022
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Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
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L34008
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10/01/2015
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02/03/2022
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Computerized Corneal Topography
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L34032
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10/01/2015
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10/06/2022
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Debridement Services
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L34037
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10/01/2015
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02/10/2022
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Flow Cytometry
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L34045
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10/01/2015
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10/27/2022
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Non-Invasive Vascular Studies
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L34046
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10/01/2015
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08/04/2022
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Speech-Language Pathology
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L34049
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10/01/2015
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06/02/2022
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Outpatient Physical and Occupational Therapy Services
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L34055
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10/01/2015
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10/06/2022
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Virtual Colonoscopy (CT Colonography)
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L34056
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10/01/2015
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10/06/2022
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Urodynamics
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L34061
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10/01/2015
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08/04/2022
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Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
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L34062
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10/01/2015
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02/10/2022
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Dialysis Access Maintenance
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L34063
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10/01/2015
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08/04/2022
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RAST Type Tests
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L34064
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10/01/2015
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03/03/2022
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Panretinal (Scatter) Laser Photocoagulation
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L34081
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10/01/2015
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03/03/2022
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Endoscopy by Capsule
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L34082
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10/01/2015
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10/06/2022
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Varicose Veins of the Lower Extremity, Treatment of
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L34084
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10/01/2015
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09/01/2022
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Transcatheter Infusion Therapy
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L34085
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10/01/2015
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03/03/2022
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Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
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L34087
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10/01/2015
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09/01/2022
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Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based
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L34090
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10/01/2015
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03/24/2022
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Laser Ablation of the Prostate
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L34171
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10/01/2015
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06/02/2022
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Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation
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L34175
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10/01/2015
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06/03/2021
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Ophthalmic Angiography (Fluorescein and Indocyanine Green)
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L34181
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10/01/2015
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06/02/2022
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Ophthalmic Biometry for Intraocular Lens Power Calculation
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L34183
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10/01/2015
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03/03/2022
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Psychiatric Inpatient Hospitalization
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L34195
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10/01/2015
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04/14/2022
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Mohs Micrographic Surgery
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L34196
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10/01/2015
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03/03/2022
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Psychiatric Partial Hospitalization Programs
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L34200
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10/01/2015
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08/04/2022
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Removal of Benign Skin Lesions
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L34246
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10/01/2015
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08/04/2022
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Routine Foot Care and Debridement of Nails
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L34337
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10/01/2015
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09/01/2022
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Transesophageal Echocardiography (TEE)
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L34338
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10/01/2015
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10/06/2022
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Transthoracic Echocardiography (TTE)
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L34353
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10/01/2015
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06/02/2022
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Outpatient Psychiatry and Psychology Services
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L34356
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10/01/2015
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04/28/2022
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Erythropoiesis Stimulating Agents (ESA)
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L34393
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10/01/2015
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04/14/2022
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Ocular Photography - External
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L34394
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10/01/2015
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10/06/2022
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Visual Fields Testing
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L34399
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10/01/2015
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06/02/2022
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Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
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L34539
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10/01/2015
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03/04/2021
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Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians
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L34540
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10/01/2015
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09/01/2022
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Stretta Procedure
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L34541
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10/01/2015
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10/06/2022
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Transtelephonic Spirometry
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L35249
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10/01/2015
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04/14/2022
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Nerve Blocks for Peripheral Neuropathy
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L35442
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10/01/2015
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08/11/2022
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MolDX: NRAS Genetic Testing
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L35891
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10/01/2015
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03/24/2022
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Intravenous Immune Globulin
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L35897
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10/01/2015
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04/14/2022
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Nerve Conduction Studies and Electromyography
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L35906
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10/01/2015
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03/31/2022
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Somatosensory Testing
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L35984
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10/01/2015
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06/16/2022
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MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
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L35986
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10/01/2015
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10/20/2022
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Special Histochemical Stains and Immunohistochemical Stains
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L36006
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10/05/2015
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04/21/2022
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MolDX: ConfirmMDx Epigenetic Molecular Assay
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L36021
|
10/01/2015
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08/18/2022
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MolDX: Molecular Diagnostic Tests (MDT)
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L36029
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10/05/2015
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02/10/2022
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Controlled Substance Monitoring and Drugs of Abuse Testing
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L36113
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10/05/2015
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08/11/2022
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MolDX: MGMT Promoter Methylation Analysis
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L36117
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10/05/2015
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06/30/2022
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MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
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L36139
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10/05/2015
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03/10/2022
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MolDX: Biomarkers in Cardiovascular Risk Assessment
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L36425
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02/01/2016
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03/10/2022
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MolDX: Breast Cancer Assay: Prosigna®
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L36460
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02/01/2016
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01/06/2022
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Bone Mass Measurement
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L36469
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02/08/2016
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12/04/2022
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Transcranial Magnetic Stimulation (TMS)
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L36485
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02/15/2016
|
07/08/2021
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MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
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L36494
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02/01/2016
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01/06/2022
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Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
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L36658
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10/24/2016
|
10/06/2022
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Proton Beam Therapy
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L36675
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10/10/2016
|
11/24/2022
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ProMark® Risk Score
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L36690
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10/10/2016
|
09/01/2022
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Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities
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L36902
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03/06/2017
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02/03/2022
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Polysomnography and Other Sleep Studies
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L36906
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03/06/2017
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02/10/2022
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GlycoMark® Testing for Glycemic Control
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L36908
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03/13/2017
|
10/06/2022
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MolDX: Percepta® Bronchial Genomic Classifier
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L36951
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03/06/2017
|
10/06/2022
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MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
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L36975
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03/06/2017
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02/03/2022
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Bladder/Urothelial Tumor Markers
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L37126
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07/10/2017
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02/03/2022
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Coenzyme Q10 (CoQ10)
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L37130
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07/10/2017
|
06/30/2022
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MolDX: DecisionDx-UM (Uveal Melanoma)
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L37254
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11/06/2017
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02/03/2022
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Chiropractic Services
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L37352
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11/06/2017
|
11/17/2022
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MolDX: Prometheus IBD sgi Diagnostic® Policy
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L37356
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03/06/2018
|
04/21/2022
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MolDX: EndoPredict Breast Cancer Gene Expression Test
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L37364
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01/07/2019
|
02/03/2022
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Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)
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L37575
|
04/01/2019
|
02/03/2022
|
Frequency of Hemodialysis
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L37578
|
03/19/2018
|
05/05/2022
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Micro-Invasive Glaucoma Surgery (MIGS)
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L37598
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12/17/2018
|
06/09/2022
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Cystatin C Measurement
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L37608
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05/06/2019
|
06/30/2022
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MDS FISH
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L37790
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10/01/2018
|
09/01/2022
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Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions
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L37832
|
04/01/2019
|
09/22/2022
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MolDX: Breast Cancer Index® (BCI) Gene Expression Test
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L37903
|
05/13/2019
|
06/16/2022
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MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer
|
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L37905
|
05/20/2019
|
05/19/2022
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MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic Test
|
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L37907
|
06/03/2019
|
07/14/2022
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MolDX: myPath Melanoma Assay
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L38016
|
06/24/2019
|
07/03/2022
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MolDX: Melanoma Risk Stratification Molecular Testing
|
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L38065
|
07/27/2020
|
10/13/2022
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MolDX: Plasma-Based Genomic Profiling in Solid Tumors
|
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L38067
|
02/10/2020
|
08/25/2022
|
MolDX: Next-Generation Sequencing for Solid Tumors
|
|
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L38070
|
02/10/2020
|
08/25/2022
|
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
|
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L38111
|
03/30/2020
|
10/06/2022
|
MolDX: Pigmented Lesion Assay
|
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L38201
|
11/18/2019
|
10/06/2022
|
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
|
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L38249
|
11/01/2020
|
05/26/2022
|
MolDX: Blood Product Molecular Antigen Typing
|
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L38268
|
04/01/2020
|
03/17/2022
|
Immune Thrombocytopenia (ITP) Therapy
|
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L38284
|
07/27/2020
|
10/20/2022
|
MolDX: Predictive Classifiers for Early Stage Non-small Cell Lung Cancer
|
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L38288
|
06/07/2020
|
11/24/2022
|
MolDX: Repeat Germline Testing
|
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L38303
|
11/09/2020
|
02/03/2022
|
MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
|
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L38307
|
04/01/2020
|
03/17/2022
|
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
|
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L38378
|
04/01/2020
|
04/07/2022
|
Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)
|
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L38394
|
08/03/2020
|
09/29/2022
|
MolDX: Pharmacogenomics Testing
|
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L38582
|
06/06/2021
|
06/23/2022
|
MolDX: Molecular Testing for Solid Organ Allograft Rejection
|
|
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L38584
|
07/25/2021
|
07/21/2022
|
MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells
|
|
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L38586
|
07/18/2021
|
|
MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
|
|
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L38662
|
11/02/2020
|
05/05/2022
|
Implantable Continuous Glucose Monitors (I-CGM)
|
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L38694
|
11/02/2020
|
|
Computed Tomography Cerebral Perfusion Analysis (CTP)
|
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L38771
|
04/25/2021
|
08/21/2022
|
Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
|
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L38773
|
05/02/2021
|
03/17/2022
|
Facet Joint Interventions for Pain Management
|
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L38777
|
03/29/2021
|
01/30/2022
|
Colon Capsule Endoscopy (CCE)
|
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L38822
|
12/26/2021
|
10/06/2022
|
MolDX: Minimal Residual Disease Testing for Cancer
|
|
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L38920
|
08/08/2021
|
06/30/2022
|
Off-label Use of Rituximab and Rituximab Biosimilars
|
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L38992
|
01/30/2022
|
07/21/2022
|
Electroretinography (ERG)
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L38997
|
07/17/2022
|
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MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer
|
|
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L39015
|
12/05/2021
|
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Epidural Steroid Injections for Pain Management
|
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L39017
|
08/21/2022
|
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MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
|
|
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L39023
|
01/03/2022
|
07/21/2022
|
Platelet Rich Plasma Injections for Non-Wound Injections
|
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L39038
|
04/17/2022
|
06/02/2022
|
MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
|
|
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L39284
|
11/20/2022
|
|
Prostate Cancer Detection with IsoPSA®
|
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