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Currently Active LCDs91
Draft LCDs17
Retired LCDs11
Currently Active Articles244
Retired Articles49

Currently Active LCDs

LCD
Effective
Date
Revision
Effective
Date
Title
CPT Codes Covered in LCD
L34526 10/01/2015 07/29/2021 Surgical Treatment of Obstructive Sleep Apnea (OSA)
L34528 10/01/2015 04/28/2022 Blepharoplasty, Blepharoptosis and Brow Lift
L34536 10/01/2015 09/30/2021 Treatment of Varicose Veins of the Lower Extremities
L34588 10/01/2015 09/30/2021 Trigger Points, Local Injections
L34594 10/01/2015 10/28/2021 Nerve Conduction Studies and Electromyography
L34596 10/01/2015 09/30/2021 Immunizations
L34614 10/01/2015 10/01/2022 Colonoscopy and Sigmoidoscopy-Diagnostic
L34615 10/01/2015 10/01/2021 Visual Fields
L34616 10/01/2015 10/01/2022 Psychiatry and Psychology Services
L34623 10/01/2015 07/28/2022 Intraoperative Neurophysiological Testing
L34624 10/01/2015 10/28/2021 Somatosensory Testing
L34633 10/01/2015 07/01/2021 Erythropoiesis Stimulating Agents (ESAs)
L34635 10/01/2015 11/14/2021 Botulinum Toxin Type A & Type B
L34636 10/01/2015 10/28/2021 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)
L34641 10/01/2015 10/17/2022 Transcranial Magnetic Stimulation (TMS)
L34645 10/01/2015 10/01/2021 Drug Testing
L34646 10/01/2015 09/29/2022 Psychological and Neuropsychological Testing
L34648 10/01/2015 08/27/2020 Bisphosphonate Drug Therapy
L34658 10/01/2015 10/01/2021 Vitamin D Assay Testing
L34659 10/01/2015 09/29/2022 Endoscopic Treatment of GERD
L34760 10/01/2015 09/30/2021 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
L34761 10/01/2015 12/30/2021 Percutaneous Coronary Interventions
L34771 10/01/2015 12/01/2022 Immune Globulins
L35121 10/01/2015 10/28/2021 Coronary Computed Tomography Angiography (CCTA)
L35124 10/01/2015 10/28/2021 Autonomic Function Testing
L35222 10/01/2015 12/30/2021 Nerve Blocks for Peripheral Neuropathy
L35486 10/01/2015 10/28/2021 Pelvic Floor Dysfunction: Anorectal Manometry and EMG
L35490 10/01/2015 06/12/2022 Category III Codes
L35494 10/01/2015 12/01/2022 Mohs Micrographic Surgery
L35498 10/01/2015 10/28/2021 Removal of Benign Skin Lesions
L35751 10/01/2015 01/27/2022 Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
L35753 10/01/2015 10/01/2021 Non-Invasive Cerebrovascular Studies
L35755 10/01/2015 10/28/2021 Non-Invasive Abdominal / Visceral Vascular Studies
L35761 10/01/2015 10/01/2021 Non-Invasive Peripheral Arterial Vascular Studies
L35998 10/01/2015 10/28/2021 Non-Coronary Vascular Stents
L36000 12/17/2015 06/30/2022 Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain
L36400 04/16/2016 08/12/2021 MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L36402 03/18/2016 10/01/2022 Allergy Testing
L36408 03/18/2016 10/01/2021 Allergy Immunotherapy
L36523 06/16/2016 04/22/2021 MolDX: Biomarkers in Cardiovascular Risk Assessment
L36797 02/16/2017 10/07/2021 MolDX: NRAS Genetic Testing
L36805 02/16/2017 09/29/2022 Lab: Special Histochemical Stains and Immunohistochemical Stains
L36807 02/16/2017 12/30/2021 MolDX: Molecular Diagnostic Tests (MDT)
L36811 02/16/2017 04/22/2021 MolDX: Breast Cancer Assay: Prosigna®
L36815 02/16/2017 06/30/2022 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
L36839 02/16/2017 07/29/2021 Polysomnography and Other Sleep Studies
L37001 07/17/2017 10/14/2021 MolDX: MGMT Promoter Methylation Analysis
L37003 07/17/2017 07/08/2021 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
L37011 07/17/2017 02/24/2022 ProMark® Risk Score
L37015 07/17/2017 05/26/2022 Visual Electrophysiology Testing
L37195 09/16/2017 10/28/2021 MolDX: Percepta® Bronchial Genomic Classifier
L37199 09/16/2017 10/28/2021 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
L37205 09/16/2017 05/26/2022 Chemotherapy Drugs and their Adjuncts
L37210 09/16/2017 06/30/2022 MolDX: Decision Dx-UM (Uveal Melanoma)
L37216 09/16/2017 09/30/2021 BDX-XL2
L37228 04/16/2018 02/24/2022 Wound Care
L37537 03/01/2019 07/28/2022 Frequency of Hemodialysis
L37539 03/19/2018 02/25/2021 MolDX: Prometheus IBD sgi Diagnostic® Policy
L37663 08/16/2018 07/04/2021 MolDX: EndoPredict® Breast Cancer Gene Expression Test
L37772 05/13/2019 09/01/2022 MDS FISH
L37913 04/15/2019 10/28/2021 MolDX: Breast Cancer Index® (BCI) Gene Expression Test
L37919 05/13/2019 06/24/2021 MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic Test
L37921 04/15/2019 10/14/2021 MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer
L37923 06/10/2019 12/30/2021 MolDX: myPath® Melanoma Assay
L38018 08/12/2019 07/03/2022 MolDX: Melanoma Risk Stratification Molecular Testing
L38158 02/09/2020 06/24/2021 MolDX: Next-Generation Sequencing for Solid Tumors
L38168 03/15/2020 12/30/2021 MolDX: Plasma-Based Genomic Profiling in Solid Tumors
L38176 02/09/2020 07/08/2021 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
L38178 04/12/2020 12/30/2021 MolDX: Pigmented Lesion Assay
L38211 10/14/2019 09/30/2021 Corneal Hysteresis
L38213 12/16/2019 09/01/2022 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
L38429 06/14/2020 12/30/2021 MolDX: Repeat Germline Testing
L38433 11/08/2020 01/27/2022 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
L38435 07/26/2020 09/29/2022 MolDX: Pharmacogenomics Testing
L38441 10/25/2020 05/26/2022 MolDX: Blood Product Molecular Antigen Typing
L38443 06/14/2020 01/06/2022 MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer
L38528 06/14/2020 04/28/2022 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
L38678 07/25/2021 05/26/2022 MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells
L38680 06/06/2021 MolDx: Molecular Testing for Solid Organ Allograft Rejection
L38682 12/27/2020 10/27/2022 Transurethral Waterjet Ablation of the Prostate
L38684 07/18/2021 MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
L38686 10/11/2020 02/28/2022 Implantable Continuous Glucose Monitors (I-CGM)
L38835 12/26/2021 12/26/2021 MolDX: Minimal Residual Disease Testing for Cancer
L38837 03/28/2021 Colon Capsule Endoscopy (CCE)
L38839 04/25/2021 08/14/2022 Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
L38841 04/25/2021 04/25/2021 Facet Joint Interventions for Pain Management
L39040 07/03/2022 07/03/2022 MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
L39042 07/03/2022 MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer
L39044 04/17/2022 04/17/2022 MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
L39051 11/14/2021 Cosmetic and Reconstructive Surgery
L39054 12/05/2021 06/30/2022 Epidural Steroid Injections for Pain Management



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