| LCD |
Effective
Date |
Revision
Effective
Date |
Title |
CPT Codes Covered in LCD |
|
L33252
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10/01/2015
|
07/01/2020
|
Psychiatric Diagnostic Evaluation and Psychotherapy Services
|
|
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L33261
|
10/01/2015
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07/11/2021
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Allergy Testing
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L33267
|
10/01/2015
|
01/08/2019
|
B-Type Natriuretic Peptide (BNP)
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|
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L33270
|
10/01/2015
|
01/21/2021
|
Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications
|
|
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L33274
|
10/01/2015
|
03/21/2021
|
Botulinum Toxins
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L33382
|
10/01/2015
|
01/08/2019
|
Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions
|
|
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L33405
|
10/01/2015
|
07/01/2020
|
Polysomnography and Sleep Testing
|
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L33411
|
10/01/2015
|
10/01/2019
|
Surgical Management of Morbid Obesity
|
|
|
L33583
|
10/01/2015
|
10/01/2019
|
Diagnostic and Therapeutic Esophagogastroduodenoscopy
|
|
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L33609
|
10/01/2015
|
01/07/2021
|
Autonomic Function Tests
|
|
|
L33618
|
10/01/2015
|
01/08/2019
|
Major Joint Replacement (Hip and Knee)
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|
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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
|
03/21/2021
|
Diagnostic Colonoscopy
|
|
|
L33674
|
10/01/2015
|
01/08/2019
|
Duplex Scanning
|
|
|
L33689
|
10/01/2015
|
01/08/2019
|
Mohs Micrographic Surgery (MMS)
|
|
|
L33693
|
10/01/2015
|
12/17/2020
|
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
|
|
|
L33751
|
10/01/2015
|
11/28/2019
|
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
|
|
|
L33756
|
10/01/2015
|
10/01/2019
|
Transesophageal Echocardiogram
|
|
|
L33766
|
10/01/2015
|
01/08/2019
|
Visual Field Examination
|
|
|
L33771
|
10/01/2015
|
10/29/2020
|
Vitamin D; 25 hydroxy, includes fraction(s), if performed
|
|
|
L33774
|
10/01/2015
|
07/11/2019
|
Wireless Capsule Endoscopy
|
|
|
L33833
|
10/01/2015
|
01/30/2022
|
Surgical Treatment of Nails
|
|
|
L33906
|
10/01/2015
|
12/12/2021
|
Epidural Steroid Injections for Pain Management
|
|
|
L33930
|
10/01/2015
|
04/25/2021
|
Facet Joint Interventions for Pain Management
|
|
|
L33969
|
10/01/2015
|
10/01/2019
|
Diagnostic Aerosol or Vapor Inhalation
|
|
|
L33975
|
10/01/2015
|
01/01/2021
|
Psychiatric Inpatient Hospitalization
|
|
|
L34007
|
10/01/2015
|
02/05/2023
|
Immune Globulin
|
|
|
L34011
|
10/01/2015
|
10/01/2019
|
Ionized Calcium
|
|
|
L34018
|
10/01/2015
|
09/07/2021
|
Parathormone (Parathyroid Hormone)
|
|
|
L34021
|
10/01/2015
|
01/08/2019
|
Sedimentation Rate, Erythrocyte
|
|
|
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
|
03/21/2021
|
Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow
|
|
|
L34372
|
10/01/2015
|
07/01/2020
|
Magnetic Resonance Angiography (MRA)
|
|
|
L34519
|
10/01/2015
|
12/12/2021
|
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
|
12/11/2022
|
Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder
|
|
|
L34859
|
10/01/2015
|
12/10/2023
|
Nerve Conduction Studies and Electromyography
|
|
|
L34912
|
10/01/2015
|
10/01/2019
|
Genetic Testing for Lynch Syndrome
|
|
|
L34976
|
10/01/2015
|
07/11/2021
|
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
|
|
|
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
|
12/10/2020
|
BRCA1 and BRCA2 Genetic Testing
|
|
|
L36767
|
10/31/2016
|
10/01/2019
|
Aortography and peripheral angiography
|
|
|
L36773
|
11/07/2016
|
07/31/2019
|
Intensity Modulated Radiation Therapy (IMRT)
|
|
|
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
|
|
|
L37798
|
03/18/2019
|
01/06/2020
|
4Kscore Test Algorithm
|
|
|
L37800
|
10/18/2018
|
07/11/2021
|
Allergen Immunotherapy
|
|
|
L38231
|
12/30/2019
|
12/27/2020
|
Endovenous Stenting
|
|
|
L38233
|
12/30/2019
|
|
Micro-Invasive Glaucoma Surgery (MIGS)
|
|
|
L38396
|
03/15/2020
|
04/25/2021
|
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
|
04/21/2022
|
Implantable Continuous Glucose Monitors (I-CGM)
|
|
|
L38720
|
12/27/2020
|
|
Treatment of Chronic Venous Insufficiency of the Lower Extremities
|
|
|
L38726
|
12/27/2020
|
|
Transurethral Waterjet Ablation of the Prostate
|
|
|
L38805
|
03/28/2021
|
|
Colon Capsule Endoscopy (CCE)
|
|
|
L38914
|
07/11/2021
|
07/11/2021
|
Cosmetic and Reconstructive Surgery
|
|
|
L38926
|
07/11/2021
|
07/11/2021
|
Cataract Extraction (including Complex Cataract Surgery)
|
|
|
L39071
|
12/12/2021
|
12/12/2021
|
Platelet Rich Plasma
|
|
|
L39073
|
12/12/2021
|
|
Pharmacogenomics Testing
|
|
|
L39084
|
01/30/2022
|
01/30/2022
|
Genetic Testing for Cardiovascular Disease
|
|
|
L39367
|
07/17/2023
|
|
Genetic Testing for Oncology
|
|
|
L39492
|
06/11/2023
|
|
Ambulatory Electrocardiograph (AECG) Monitoring
|
|
