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Currently Active LCDs98
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Currently Active LCDs

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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 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)

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