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CodeMap® CodeMap® Contractor Policy Detail

List of All Medicare MAC Part A and MAC Part B Contractors

Noridian Healthcare Solutions, LLC
Montana
MAC B
03202

Currently Active LCDs94
Draft LCDs16
Retired LCDs10
Currently Active Articles327
Retired Articles18

Currently Active 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
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 01/10/2021 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
L34980 10/01/2015 10/01/2019 Lumbar Epidural Injections
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 08/12/2021 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
L36186 04/19/2016 11/01/2019 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
L36192 04/15/2016 10/14/2021 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 12/10/2020 MolDX: ConfirmMDx Epigenetic Molecular Assay
L36339 07/05/2016 10/07/2021 MolDX: NRAS Genetic Testing
L36353 10/15/2015 12/24/2020 Lab: Special Histochemical Stains and Immunohistochemical Stains
L36362 06/01/2016 10/01/2019 MolDX: Biomarkers in Cardiovascular Risk Assessment
L36374 06/01/2016 01/07/2021 MolDX: Genetic Testing for Lynch Syndrome
L36386 05/03/2016 04/22/2021 MolDX: Breast Cancer Assay: Prosigna®
L36526 06/01/2016 12/01/2019 Nerve Conduction Studies and Electromyography
L36544 09/15/2016 07/08/2021 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 03/04/2021 Lab: Bladder/Urothelial Tumor Markers
L36700 03/13/2017 10/01/2019 Serum Magnesium
L36706 06/01/2017 12/30/2021 ProMark® Risk Score
L36707 06/28/2016 04/08/2021 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 03/04/2021 GlycoMark® Testing for Glycemic Control
L36868 07/17/2017 10/01/2019 Diagnostic and Therapeutic Colonoscopy
L36884 05/15/2017 04/01/2021 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 11/25/2021 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 02/25/2021 Lab: Coenzyme Q10 (CoQ10)
L37072 09/22/2017 07/08/2021 MolDX: DecisionDx-UM (Uveal Melanoma)
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 07/11/2021 MolDX: EndoPredict® Breast Cancer Gene Expression Test
L37313 01/30/2018 02/25/2021 MolDX: Prometheus IBD sgi Diagnostic® Policy
L37315 05/13/2019 10/01/2019 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
L37360 08/27/2018 12/01/2019 Peripheral Nerve Stimulation
L37368 02/11/2019 08/05/2021 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 12/10/2020 MolDX: Cystatin C Measurement
L37622 06/03/2019 07/22/2021 MDS FISH
L37630 10/01/2018 02/25/2020 In Vitro Chemosensitivity & Chemoresistance Assays
L37675 02/10/2019 06/03/2021 MolDX: Corus® CAD Assay
L37738 04/01/2019 11/01/2019 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor
L37748 02/10/2019 12/06/2020 MolDX: Melanoma Risk Stratification Molecular Testing
L37824 04/16/2019 10/28/2021 MolDX: Breast Cancer Index® (BCI) Gene Expression Test
L37881 06/03/2019 11/04/2021 MolDX: myPath® Melanoma Assay
L37891 05/27/2019 06/24/2021 MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic Test
L37899 06/03/2019 10/14/2021 MolDX: Inivata™, InvisionFirst®, Liquid Biopsy for Patients with Lung Cancer
L38121 05/17/2020 06/24/2021 MolDX: Next-Generation Sequencing for Solid Tumors
L38125 05/17/2020 07/08/2021 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
L38153 06/07/2020 MolDX: Pigmented Lesion Assay
L38301 03/23/2020 10/03/2021 Micro-Invasive Glaucoma Surgery (MIGS)
L38312 03/15/2020 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
L38329 08/24/2020 01/06/2022 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 12/30/2021 MolDX: Repeat Germline Testing
L38380 12/06/2020 MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts
L38615 04/26/2021 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease
L38645 07/04/2021 MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells
L38649 07/25/2021 MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
L38659 11/02/2020 Implantable Continuous Glucose Monitors (I-CGM)
L38671 07/04/2021 MolDX: Molecular Testing for Solid Organ Allograft Rejection
L38700 12/13/2020 Computed Tomography Cerebral Perfusion Analysis (CTP)
L38707 12/27/2020 Transurethral Waterjet Ablation of the Prostate
L38803 04/25/2021 Facet Joint Interventions for Pain Management
L38816 01/02/2022 MolDX: Minimal Residual Disease Testing for Cancer
L38826 03/28/2021 12/19/2021 Colon Capsule Endoscopy (CCE)
L38904 11/28/2021 Wound and Ulcer Care
L39060 01/23/2022 Platelet Rich Plasma Injections for Non-Wound Injections



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