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Currently Active LCDs95
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Currently Active LCDs

All LCDs Laboratory LCDs Radiology LCDs
LCD
Effective
Date
Revision
Effective
Date
Title
CPT Codes Covered in LCD
L33252 10/01/2015 07/01/2020 Psychiatric Diagnostic Evaluation and Psychotherapy Services
L33256 10/01/2015 01/08/2019 3D Interpretation and Reporting of Imaging Studies
L33261 10/01/2015 07/01/2020 Allergy Testing
L33267 10/01/2015 01/08/2019 B-Type Natriuretic Peptide (BNP)
L33270 10/01/2015 10/15/2019 Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications
L33271 10/01/2015 01/08/2019 Biventricular Pacing/Cardiac Resynchronization Therapy
L33274 10/01/2015 01/08/2019 Botulinum Toxins
L33282 10/01/2015 10/01/2019 Computed Tomographic Angiography of the Chest, Heart and Coronary Arteries
L33380 10/01/2015 10/01/2019 Long-Term Wearable Electrocardiographic Monitoring (WEM)
L33382 10/01/2015 01/08/2019 Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions
L33405 10/01/2015 07/01/2020 Polysomnography and Sleep Testing
L33406 10/01/2015 01/08/2019 Posterior Tibial Nerve Stimulation (PTNS)
L33410 10/01/2015 04/19/2020 Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
L33411 10/01/2015 10/01/2019 Surgical Management of Morbid Obesity
L33413 10/01/2015 10/01/2019 Therapy and Rehabilitation Services
L33583 10/01/2015 10/01/2019 Diagnostic and Therapeutic Esophagogastroduodenoscopy
L33609 10/01/2015 01/08/2019 Autonomic Function Tests
L33615 10/01/2015 01/08/2019 Biofeedback
L33618 10/01/2015 01/08/2019 Major Joint Replacement (Hip and Knee)
L33661 10/01/2015 01/08/2019 Flow Cytometry
L33667 10/01/2015 10/01/2019 Duplex Scan Of Lower Extremity Arteries
L33669 10/01/2015 10/01/2019 Electrocardiography
L33671 10/01/2015 07/30/2019 Diagnostic Colonoscopy
L33674 10/01/2015 01/08/2019 Duplex Scanning
L33684 10/01/2015 07/01/2019 Hemophilia Clotting Factors
L33685 10/01/2015 01/08/2019 Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
L33689 10/01/2015 01/08/2019 Mohs Micrographic Surgery (MMS)
L33693 10/01/2015 10/01/2019 Non-Invasive Evaluation of Extremity Veins
L33695 10/01/2015 01/08/2019 Non-invasive Extracranial Arterial Studies
L33696 10/01/2015 10/01/2019 Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries
L33704 10/01/2015 01/08/2019 Infliximab
L33707 10/01/2015 07/01/2020 Pulmonary Diagnostic Services
L33747 10/01/2015 02/26/2020 Pegfilgrastim
L33751 10/01/2015 11/28/2019 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
L33754 10/01/2015 10/15/2019 Syphilis Test
L33755 10/01/2015 10/01/2019 Susceptibility Studies
L33756 10/01/2015 10/01/2019 Transesophageal Echocardiogram
L33762 10/01/2015 11/27/2019 Treatment of varicose veins of the lower extremity
L33763 10/01/2015 10/01/2019 Vascular Stenting of Lower Extremity Arteries
L33766 10/01/2015 01/08/2019 Visual Field Examination
L33767 10/01/2015 10/01/2019 Viscosupplementation Therapy For Knee
L33768 10/01/2015 10/01/2019 Transthoracic Echocardiography (TTE)
L33771 10/01/2015 01/08/2019 Vitamin D; 25 hydroxy, includes fraction(s), if performed
L33774 10/01/2015 07/11/2019 Wireless Capsule Endoscopy
L33969 10/01/2015 10/01/2019 Diagnostic Aerosol or Vapor Inhalation
L33974 10/01/2015 10/01/2019 Troponin
L33975 10/01/2015 11/28/2019 Psychiatric Inpatient Hospitalization
L34002 10/01/2015 01/08/2019 G-CSF Filgrastim
L34007 10/01/2015 11/28/2019 Intravenous Immune Globulin
L34011 10/01/2015 10/01/2019 Ionized Calcium
L34014 10/01/2015 10/01/2019 Magnesium
L34018 10/01/2015 10/01/2019 Parathormone (Parathyroid Hormone)
L34021 10/01/2015 01/08/2019 Sedimentation Rate, Erythrocyte
L34022 10/01/2015 01/08/2019 Serum Phosphorus
L34026 10/01/2015 10/01/2019 Trastuzumab – Trastuzumab Biologics
L34027 10/01/2015 01/08/2019 Ultrasound, Soft Tissues of Head and Neck
L34028 10/01/2015 01/08/2019 Upper Eyelid and Brow Surgical Procedures
L34372 10/01/2015 07/01/2020 Magnetic Resonance Angiography (MRA)
L34518 10/01/2015 01/08/2019 Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing
L34519 10/01/2015 10/01/2019 Molecular Pathology Procedures
L34520 10/01/2015 07/01/2020 Psychological and Neuropsychological Tests
L34521 10/01/2015 01/08/2019 Special EEG Tests
L34522 10/01/2015 11/28/2019 Transcranial Magnetic Stimulation for Major Depressive Disorder
L34859 10/01/2015 10/01/2019 Nerve Conduction Studies and Electromyography
L34912 10/01/2015 10/01/2019 Genetic Testing for Lynch Syndrome
L34976 10/01/2015 07/12/2020 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
L35698 10/01/2015 07/01/2020 CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
L36035 10/01/2015 11/28/2019 Spinal Cord Stimulation for Chronic Pain
L36230 11/15/2015 01/08/2019 Evaluation and Management Services in a Nursing Facility
L36234 12/06/2015 11/28/2019 Special Histochemical Stains & Immunohistochemical Stains
L36237 10/01/2015 01/08/2019 Amniotic Membrane- Sutureless Placement on the Ocular Surface
L36238 10/01/2015 01/08/2019 Humanitarian Use Device (HUD) and Humanitarian Device Exemption (HDE) process
L36276 10/01/2015 10/29/2019 Erythropoiesis Stimulating Agents
L36356 10/01/2015 09/10/2019 Bone Mineral Density Studies
L36377 10/01/2015 01/08/2019 Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities
L36393 10/11/2015 10/01/2019 Controlled Substance Monitoring and Drugs of Abuse Testing
L36499 04/11/2016 10/01/2019 BRCA1 and BRCA2 Genetic Testing
L36617 09/12/2016 01/08/2019 Chiropractic Services
L36767 10/31/2016 10/01/2019 Aortography and peripheral angiography
L36773 11/07/2016 07/31/2019 Intensity Modulated Radiation Therapy (IMRT)
L36962 07/24/2017 10/01/2019 Vascular Endothelial Growth Factor Inhibitors for the Treatment of Ophthalmological Diseases
L37166 12/07/2017 07/23/2020 Wound Care
L37398 02/02/2018 11/28/2019 Electroretinography (ERG)
L37561 02/02/2018 11/28/2019 Cystatin C Measurement
L37564 03/01/2019 07/01/2019 Frequency of Hemodialysis
L37697 06/28/2018 11/28/2019 Emergency and Non-Emergency Ground Ambulance Services
L37798 03/18/2019 01/06/2020 4Kscore Test Algorithm
L37943 08/12/2019 08/12/2019 Anorectal Manometry and Electromyography (EMG) of the Urinary and Anal Sphincters
L38227 12/30/2019 Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)
L38231 12/30/2019 Endovenous Stenting
L38233 12/30/2019 Micro-Invasive Glaucoma Surgery (MIGS)
L38396 03/15/2020 Cardiology Non-emergent Outpatient Stress Testing
L38398 03/15/2020 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
L38506 07/12/2020 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor
L38664 10/11/2020 Implantable Continuous Glucose Monitors (I-CGM)



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