LCD |
Effective Date |
Revision Effective Date |
Title |
CPT Codes Covered in LCD |
L33394
|
10/01/2015
|
08/01/2024
|
Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
|
|
L33396
|
10/01/2015
|
10/24/2019
|
Posterior Tibial Nerve Stimulation for Voiding Dysfunction
|
|
L33398
|
10/01/2015
|
04/01/2023
|
Transcranial Magnetic Stimulation
|
|
L33399
|
10/01/2015
|
01/01/2020
|
EEG – Ambulatory Monitoring
|
|
L33557
|
10/01/2015
|
10/01/2019
|
Cardiac Catheterization and Coronary Angiography
|
|
L33558
|
10/01/2015
|
09/19/2019
|
Cataract Extraction
|
|
L33559
|
10/01/2015
|
04/01/2022
|
Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
|
|
L33560
|
10/01/2015
|
01/01/2021
|
Cardiovascular Nuclear Medicine
|
|
L33562
|
10/01/2015
|
09/12/2019
|
Computed Tomographic (CT) Colonography for Diagnostic Uses
|
|
L33563
|
10/01/2015
|
09/12/2019
|
Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures
|
|
L33567
|
10/01/2015
|
10/01/2019
|
Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
|
|
L33569
|
10/01/2015
|
12/01/2020
|
Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
|
|
L33573
|
10/01/2015
|
11/07/2019
|
B-type Natriuretic Peptide (BNP) Testing
|
|
L33574
|
10/01/2015
|
09/19/2019
|
Visual Fields Testing
|
|
L33575
|
10/01/2015
|
11/21/2019
|
Varicose Veins of the Lower Extremity, Treatment of
|
|
L33576
|
10/01/2015
|
10/24/2019
|
Urodynamics
|
|
L33577
|
10/01/2015
|
10/01/2019
|
Transthoracic Echocardiography (TTE)
|
|
L33578
|
10/01/2015
|
10/10/2019
|
Transrectal Ultrasound
|
|
L33579
|
10/01/2015
|
11/24/2024
|
Transesophageal Echocardiography (TEE)
|
|
L33580
|
10/01/2015
|
12/19/2019
|
Speech-Language Pathology
|
|
L33585
|
10/01/2015
|
10/24/2019
|
Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
|
|
L33591
|
10/01/2015
|
11/07/2019
|
RAST Type Tests
|
|
L33614
|
10/01/2015
|
11/07/2019
|
Debridement Services
|
|
L33616
|
10/01/2015
|
11/21/2019
|
Osteopathic Manipulative Treatment
|
|
L33619
|
10/01/2015
|
10/01/2019
|
Nonvascular Extremity Ultrasound
|
|
L33621
|
10/01/2015
|
09/19/2019
|
Ophthalmic Biometry for Intraocular Lens Power Calculation
|
|
L33622
|
10/01/2015
|
04/01/2024
|
Pain Management - Injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels
|
|
L33623
|
10/01/2015
|
11/07/2019
|
Percutaneous Coronary Intervention
|
|
L33624
|
10/01/2015
|
11/14/2019
|
Psychiatric Inpatient Hospitalization
|
|
L33626
|
10/01/2015
|
01/01/2023
|
Psychiatric Partial Hospitalization Programs
|
|
L33627
|
10/01/2015
|
10/01/2019
|
Non-Invasive Vascular Studies
|
|
L33628
|
10/01/2015
|
09/19/2019
|
Panretinal (Scatter) Laser Photocoagulation
|
|
L33630
|
10/01/2015
|
09/12/2019
|
Corneal Pachymetry
|
|
L33631
|
10/01/2015
|
01/01/2020
|
Outpatient Physical and Occupational Therapy Services
|
|
L33632
|
10/01/2015
|
01/01/2024
|
Psychiatry and Psychology Services
|
|
L33633
|
10/01/2015
|
10/01/2019
|
Magnetic Resonance Angiography (MRA)
|
|
L33636
|
10/01/2015
|
08/18/2022
|
Routine Foot Care and Debridement of Nails
|
|
L33646
|
10/01/2015
|
05/01/2021
|
Botulinum Toxins
|
|
L34380
|
10/01/2015
|
09/19/2019
|
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
|
|
L35000
|
10/01/2015
|
08/01/2024
|
Molecular Pathology Procedures
|
|
L35001
|
10/01/2015
|
02/01/2024
|
Reduction Mammaplasty
|
|
L35028
|
10/01/2015
|
11/14/2019
|
Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency
|
|
L35074
|
10/01/2015
|
04/15/2021
|
Heavy Metal Testing
|
|
L35075
|
10/01/2015
|
11/07/2019
|
Proton Beam Therapy
|
|
L35076
|
10/01/2015
|
04/01/2020
|
Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
|
|
L35080
|
10/01/2015
|
02/10/2022
|
Select Minimally Invasive GERD Procedures
|
|
L35098
|
10/01/2015
|
11/21/2019
|
Nerve Conduction Studies and Electromyography
|
|
L35936
|
10/01/2015
|
08/01/2024
|
Facet Joint Interventions for Pain Management
|
|
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
|
|
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
|
12/15/2024
|
Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)
|
|
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
|
|
L39513
|
08/01/2023
|
|
Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin
|
|