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Currently Active LCDs100
Draft LCDs29
Retired LCDs7
Currently Active Articles326
Retired Articles22

Currently Active LCDs

All LCDs Laboratory LCDs Radiology LCDs
LCD
Effective
Date
Revision
Effective
Date
Title
CPT Codes Covered in LCD
L33979 10/01/2015 10/01/2019 Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
L34010 10/01/2015 12/01/2019 Treatment of Varicose Veins of the Lower Extremities
L34038 10/01/2015 10/01/2019 B-type Natriuretic Peptide (BNP) Testing
L34040 10/01/2015 12/01/2019 Polysomnography and Other Sleep Studies
L34051 10/01/2015 12/01/2019 Vitamin D Assay Testing
L34066 10/01/2015 12/01/2019 MolDX: Circulating Tumor Cell Marker Assays
L34074 10/01/2015 02/01/2020 Immune Globulin Intravenous (IVIg)
L34076 10/01/2015 10/01/2019 Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
L34106 10/01/2015 02/19/2020 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
L34151 10/01/2015 12/01/2019 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
L34199 10/01/2015 10/01/2019 Treatment of Ulcers & Symptomatic Hyperkeratoses
L34980 10/01/2015 10/01/2019 Lumbar Epidural Injections
L34995 10/01/2015 12/01/2019 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
L35172 10/01/2015 10/01/2019 Botulinum Toxin Types A and B
L35175 10/01/2015 10/01/2019 MRI and CT Scans of the Head and Neck
L35457 10/01/2015 12/01/2019 Nerve Blockade for Treatment of Chronic Pain and Neuropathy
L35704 10/01/2015 12/01/2019 Mohs Micrographic Surgery
L36094 10/01/2015 12/01/2019 Lab: Flow Cytometry
L36159 06/16/2016 11/01/2019 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L36163 04/15/2016 12/04/2019 MolDX: BRCA1 and BRCA2 Genetic Testing
L36171 04/01/2016 11/01/2019 MolDX: Molecular RBC Phenotyping
L36186 04/19/2016 11/01/2019 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
L36192 04/15/2016 11/01/2019 MolDX: MGMT Promoter Methylation Analysis
L36204 06/01/2016 12/01/2019 Spinal Cord Stimulators for Chronic Pain
L36256 10/01/2015 11/01/2019 MolDX: Molecular Diagnostic Tests (MDT)
L36286 10/01/2015 10/01/2019 Blepharoplasty, Eyelid Surgery, and Brow Lift
L36329 10/01/2015 11/01/2019 MolDX: ConfirmMDx Epigenetic Molecular Assay
L36339 07/05/2016 12/01/2019 MolDX: NRAS Genetic Testing
L36345 10/15/2015 12/01/2019 MolDX: Decipher® Prostate Cancer Classifier Assay
L36350 10/15/2015 12/01/2019 MolDX: Prolaris™ Prostate Cancer Genomic Assay
L36353 10/15/2015 12/01/2019 Lab: Special Histochemical Stains and Immunohistochemical Stains
L36362 06/01/2016 10/01/2019 MolDX: Biomarkers in Cardiovascular Risk Assessment
L36368 07/05/2016 11/01/2019 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
L36374 06/01/2016 11/01/2019 MolDX: Genetic Testing for Lynch Syndrome
L36386 05/03/2016 11/01/2019 MolDX: Breast Cancer Assay: Prosigna
L36526 06/01/2016 12/01/2019 Nerve Conduction Studies and Electromyography
L36544 09/15/2016 11/01/2019 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
L36569 07/12/2016 11/01/2019 Treatment of Males with Low Testosterone
L36573 09/07/2016 12/01/2019 Total Hip Arthroplasty
L36577 09/07/2016 12/01/2019 Total Knee Arthroplasty
L36680 05/16/2017 10/01/2019 Lab: Bladder/Urothelial Tumor Markers
L36700 03/13/2017 10/01/2019 Serum Magnesium
L36706 06/01/2017 12/01/2019 MolDX: ProMark Risk Score
L36707 06/28/2016 10/01/2019 Lab: Controlled Substance Monitoring and Drugs of Abuse Testing
L36857 07/21/2017 11/01/2019 Measurement of Salivary Hormones
L36859 05/26/2017 12/01/2019 Trigger Point Injections
L36866 08/01/2017 10/01/2019 GlycoMark Testing for Glycemic Control
L36868 07/17/2017 10/01/2019 Diagnostic and Therapeutic Colonoscopy
L36884 05/15/2017 11/01/2019 MolDX: APC and MUTYH Gene Testing
L36889 07/17/2017 10/01/2019 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography
L36891 05/15/2017 12/01/2019 MolDX: Percepta© Bronchial Genomic Classifier
L36947 03/27/2017 12/01/2019 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
L37020 10/10/2017 10/01/2019 Plastic Surgery
L37027 10/10/2017 10/01/2019 Cataract Surgery in Adults
L37062 09/29/2017 11/01/2019 MolDX: BDX-XL2
L37068 10/02/2017 01/01/2020 Lab: Coenzyme Q10 (CoQ10)
L37072 09/22/2017 12/01/2019 MolDX: DecisionDx-UM (Uveal Melanoma)
L37082 09/25/2017 12/01/2019 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
L37088 05/14/2018 12/01/2019 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder
L37122 01/13/2019 11/01/2019 MolDX: 4Kscore Assay
L37281 08/27/2018 10/01/2019 Lumbar MRI
L37283 03/26/2018 10/01/2019 Electrocardiograms
L37293 07/09/2018 10/01/2019 Respiratory Care (Respiratory Therapy)
L37311 01/30/2018 11/01/2019 MolDX: EndoPredict® Breast Cancer Gene Expression Test
L37313 01/30/2018 12/01/2019 MolDX: Prometheus IBD sgi Diagnostic Policy
L37315 05/13/2019 10/01/2019 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
L37321 03/18/2018 11/01/2019 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
L37358 12/11/2017 11/01/2019 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test
L37360 08/27/2018 12/01/2019 Peripheral Nerve Stimulation
L37368 02/11/2019 10/01/2019 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)
L37504 02/18/2019 10/01/2019 Frequency of Hemodialysis
L37549 06/22/2018 11/01/2019 Chest X-Ray Policy
L37618 02/11/2019 11/01/2019 MolDX: Cystatin C Measurement
L37622 06/03/2019 11/01/2019 MolDX: MDS FISH
L37630 10/01/2018 12/01/2019 In Vitro Chemosensitivity & Chemoresistance Assays
L37675 02/10/2019 11/01/2019 MolDX: Corus® CAD Assay
L37738 04/01/2019 11/01/2019 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor
L37744 03/02/2019 12/06/2020 MolDX: Androgen Receptor Variant (AR-V7) Protein Test
L37748 02/10/2019 12/06/2020 MolDX: Melanoma Risk Stratification Molecular Testing
L37820 05/27/2019 11/01/2019 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease
L37824 04/16/2019 01/01/2020 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test
L37881 06/03/2019 11/01/2019 MolDX: myPath Melanoma Assay
L37891 05/27/2019 11/01/2019 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
L37899 06/03/2019 11/01/2019 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer
L38121 05/17/2020 MolDX: Next-Generation Sequencing for Solid Tumors
L38125 05/17/2020 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
L38137 01/05/2020 01/05/2020 MolDX: TruGraf Blood Gene Expression Test
L38149 05/04/2020 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease
L38153 06/07/2020 MolDX: Pigmented Lesion Assay
L38301 03/23/2020 03/23/2020 Micro-Invasive Glaucoma Surgery (MIGS)
L38312 03/15/2020 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
L38329 08/24/2020 MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer
L38333 12/06/2020 12/06/2020 MolDX: Blood Product Molecular Antigen Typing
L38337 08/17/2020 MolDX: Pharmacogenomics Testing
L38341 12/06/2020 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
L38353 08/03/2020 MolDX: Repeat Germline Testing
L38380 12/06/2020 MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts
L38659 11/02/2020 Implantable Continuous Glucose Monitors (I-CGM)
L38700 12/13/2020 Computed Tomography Cerebral Perfusion Analysis (CTP)
L38707 12/27/2020 Transurethral Waterjet Ablation of the Prostate



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