| LCD |
Effective
Date |
Revision
Effective
Date |
Title |
CPT Codes Covered in LCD |
|
L33394
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10/01/2015
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08/01/2024
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Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
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L33396
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10/01/2015
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10/24/2019
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Posterior Tibial Nerve Stimulation for Voiding Dysfunction
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L33398
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10/01/2015
|
04/01/2023
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Transcranial Magnetic Stimulation
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L33399
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10/01/2015
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01/01/2020
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EEG – Ambulatory Monitoring
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L33557
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10/01/2015
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10/01/2019
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Cardiac Catheterization and Coronary Angiography
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L33558
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10/01/2015
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09/19/2019
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Cataract Extraction
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L33559
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10/01/2015
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04/01/2022
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Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
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L33560
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10/01/2015
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01/01/2021
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Cardiovascular Nuclear Medicine
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L33562
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10/01/2015
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09/12/2019
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Computed Tomographic (CT) Colonography for Diagnostic Uses
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L33563
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10/01/2015
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09/12/2019
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Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures
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L33567
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10/01/2015
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10/01/2019
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Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
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L33569
|
10/01/2015
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12/01/2020
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Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
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L33573
|
10/01/2015
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11/07/2019
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B-type Natriuretic Peptide (BNP) Testing
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L33574
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10/01/2015
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09/19/2019
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Visual Fields Testing
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L33575
|
10/01/2015
|
11/21/2019
|
Varicose Veins of the Lower Extremity, Treatment of
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L33576
|
10/01/2015
|
10/24/2019
|
Urodynamics
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L33577
|
10/01/2015
|
10/01/2019
|
Transthoracic Echocardiography (TTE)
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L33578
|
10/01/2015
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10/10/2019
|
Transrectal Ultrasound
|
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L33579
|
10/01/2015
|
11/24/2024
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Transesophageal Echocardiography (TEE)
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L33580
|
10/01/2015
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12/19/2019
|
Speech-Language Pathology
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L33585
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10/01/2015
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10/24/2019
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Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
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L33591
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10/01/2015
|
11/07/2019
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RAST Type Tests
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L33614
|
10/01/2015
|
11/07/2019
|
Debridement Services
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L33616
|
10/01/2015
|
11/21/2019
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Osteopathic Manipulative Treatment
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L33619
|
10/01/2015
|
10/01/2019
|
Nonvascular Extremity Ultrasound
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L33621
|
10/01/2015
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09/19/2019
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Ophthalmic Biometry for Intraocular Lens Power Calculation
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L33622
|
10/01/2015
|
04/01/2024
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Pain Management - Injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels
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L33623
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10/01/2015
|
11/07/2019
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Percutaneous Coronary Intervention
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L33624
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10/01/2015
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11/14/2019
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Psychiatric Inpatient Hospitalization
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L33626
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10/01/2015
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01/01/2023
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Psychiatric Partial Hospitalization Programs
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L33627
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10/01/2015
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10/01/2019
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Non-Invasive Vascular Studies
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L33628
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10/01/2015
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09/19/2019
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Panretinal (Scatter) Laser Photocoagulation
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L33630
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10/01/2015
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09/12/2019
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Corneal Pachymetry
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L33631
|
10/01/2015
|
01/01/2020
|
Outpatient Physical and Occupational Therapy Services
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L33632
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10/01/2015
|
01/01/2024
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Psychiatry and Psychology Services
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L33633
|
10/01/2015
|
10/01/2019
|
Magnetic Resonance Angiography (MRA)
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L33636
|
10/01/2015
|
08/18/2022
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Routine Foot Care and Debridement of Nails
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L33646
|
10/01/2015
|
05/01/2021
|
Botulinum Toxins
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L34380
|
10/01/2015
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09/19/2019
|
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
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L35000
|
10/01/2015
|
08/01/2024
|
Molecular Pathology Procedures
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L35001
|
10/01/2015
|
02/01/2024
|
Reduction Mammaplasty
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L35028
|
10/01/2015
|
11/14/2019
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Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency
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L35074
|
10/01/2015
|
04/15/2021
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Heavy Metal Testing
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L35075
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10/01/2015
|
11/07/2019
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Proton Beam Therapy
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L35076
|
10/01/2015
|
04/01/2020
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Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
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L35080
|
10/01/2015
|
02/10/2022
|
Select Minimally Invasive GERD Procedures
|
|
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L35098
|
10/01/2015
|
11/21/2019
|
Nerve Conduction Studies and Electromyography
|
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|
L35936
|
10/01/2015
|
08/01/2024
|
Facet Joint Interventions for Pain Management
|
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L36039
|
12/01/2015
|
10/10/2019
|
Total Joint Arthroplasty
|
|
|
L36236
|
10/01/2015
|
09/12/2019
|
Autonomic Function Testing
|
|
|
L36406
|
04/01/2016
|
10/10/2019
|
Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
|
|
|
L36831
|
03/16/2017
|
10/17/2019
|
Visual Electrophysiology Testing
|
|
|
L36850
|
05/01/2017
|
11/21/2019
|
Peripheral Nerve Blocks
|
|
|
L37244
|
12/01/2017
|
11/17/2024
|
Micro-Invasive Glaucoma Surgery (MIGS)
|
|
|
L37421
|
04/01/2018
|
04/21/2022
|
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
|
|
|
L37475
|
03/01/2019
|
10/01/2019
|
Frequency of Hemodialysis
|
|
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L37535
|
04/01/2018
|
10/01/2021
|
Vitamin D Assay Testing
|
|
|
L37606
|
08/01/2018
|
10/03/2019
|
Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases
|
|
|
L37810
|
04/01/2019
|
04/01/2022
|
Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms
|
|
|
L37851
|
04/01/2019
|
02/10/2022
|
Biomarker Testing for Neuroendocrine Tumors/Neoplasms
|
|
|
L38014
|
08/01/2019
|
09/19/2019
|
Corneal Hysteresis
|
|
|
L38367
|
04/01/2020
|
04/01/2024
|
Fluid Jet System Treatment for LUTS/BPH
|
|
|
L38371
|
07/01/2020
|
07/01/2020
|
Multimarker Serum Tests Related to Ovarian Cancer Testing
|
|
|
L38387
|
04/01/2020
|
04/01/2020
|
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
|
|
|
L38571
|
04/15/2021
|
02/15/2022
|
Colon Capsule Endoscopy (CCE)
|
|
|
L38623
|
12/01/2020
|
08/14/2024
|
Implantable Continuous Glucose Monitors (I-CGM)
|
|
|
L38667
|
11/01/2020
|
|
Computed Tomography Cerebral Perfusion Analysis (CTP)
|
|
|
L38937
|
08/01/2021
|
02/10/2022
|
Platelet Rich Plasma
|
|
|
L38968
|
12/01/2021
|
|
Thyroid Nodule Molecular Testing
|
|
|
L39036
|
12/05/2021
|
11/23/2023
|
Epidural Steroid Injections for Pain Management
|
|
|
L39075
|
04/01/2022
|
04/01/2023
|
Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
|
|
|
L39139
|
12/24/2023
|
|
Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
|
|
|
L39189
|
08/01/2022
|
|
Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)
|
|
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L39226
|
08/01/2022
|
|
Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)
|
|
|
L39297
|
11/01/2022
|
|
Off-label Use of Rituximab and Rituximab Biosimilars
|
|
|
L39314
|
11/01/2022
|
|
Off-Label Use of Intravenous Immune Globulin (IVIG)
|
|
|
L39455
|
03/19/2023
|
08/10/2023
|
Sacroiliac Joint Injections and Procedures
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