| LCD |
Effective
Date |
Revision
Effective
Date |
Title |
CPT Codes Covered in LCD |
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L33252
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10/01/2015
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07/01/2020
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Psychiatric Diagnostic Evaluation and Psychotherapy Services
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L33256
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10/01/2015
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01/08/2019
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3D Interpretation and Reporting of Imaging Studies
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L33261
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10/01/2015
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07/11/2021
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Allergy Testing
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L33267
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10/01/2015
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01/08/2019
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B-Type Natriuretic Peptide (BNP)
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L33270
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10/01/2015
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01/21/2021
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Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications
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L33274
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10/01/2015
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03/21/2021
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Botulinum Toxins
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L33380
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10/01/2015
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10/01/2019
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Long-Term Wearable Electrocardiographic Monitoring (WEM)
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L33382
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10/01/2015
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01/08/2019
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Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions
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L33405
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10/01/2015
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07/01/2020
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Polysomnography and Sleep Testing
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L33411
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10/01/2015
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10/01/2019
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Surgical Management of Morbid Obesity
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L33583
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10/01/2015
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10/01/2019
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Diagnostic and Therapeutic Esophagogastroduodenoscopy
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L33609
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10/01/2015
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01/07/2021
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Autonomic Function Tests
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L33618
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10/01/2015
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01/08/2019
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Major Joint Replacement (Hip and Knee)
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L33667
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10/01/2015
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10/01/2019
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Duplex Scan Of Lower Extremity Arteries
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L33669
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10/01/2015
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10/01/2019
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Electrocardiography
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L33671
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10/01/2015
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03/21/2021
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Diagnostic Colonoscopy
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L33674
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10/01/2015
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01/08/2019
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Duplex Scanning
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L33689
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10/01/2015
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01/08/2019
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Mohs Micrographic Surgery (MMS)
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L33693
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10/01/2015
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12/17/2020
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Non-Invasive Evaluation of Extremity Veins
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L33695
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10/01/2015
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01/08/2019
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Non-invasive Extracranial Arterial Studies
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L33696
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10/01/2015
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10/01/2019
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Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries
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L33707
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10/01/2015
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07/01/2020
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Pulmonary Diagnostic Services
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L33751
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10/01/2015
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11/28/2019
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Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
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L33755
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10/01/2015
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10/01/2019
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Susceptibility Studies
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L33756
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10/01/2015
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10/01/2019
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Transesophageal Echocardiogram
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L33766
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10/01/2015
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01/08/2019
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Visual Field Examination
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L33771
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10/01/2015
|
10/29/2020
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Vitamin D; 25 hydroxy, includes fraction(s), if performed
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L33774
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10/01/2015
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07/11/2019
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Wireless Capsule Endoscopy
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L33833
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10/01/2015
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01/30/2022
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Surgical Treatment of Nails
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L33906
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10/01/2015
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12/12/2021
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Epidural Steroid Injections for Pain Management
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L33930
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10/01/2015
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04/25/2021
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Facet Joint Interventions for Pain Management
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L33969
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10/01/2015
|
10/01/2019
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Diagnostic Aerosol or Vapor Inhalation
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L33974
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10/01/2015
|
10/01/2019
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Troponin
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L33975
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10/01/2015
|
01/01/2021
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Psychiatric Inpatient Hospitalization
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L34007
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10/01/2015
|
02/05/2023
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Immune Globulin
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L34011
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10/01/2015
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10/01/2019
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Ionized Calcium
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L34014
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10/01/2015
|
10/01/2019
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Magnesium
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L34018
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10/01/2015
|
09/07/2021
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Parathormone (Parathyroid Hormone)
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L34021
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10/01/2015
|
01/08/2019
|
Sedimentation Rate, Erythrocyte
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L34022
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10/01/2015
|
11/11/2021
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Serum Phosphorus
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L34026
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10/01/2015
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10/01/2019
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Trastuzumab – Trastuzumab Biologics
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L34027
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10/01/2015
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01/08/2019
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Ultrasound, Soft Tissues of Head and Neck
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L34028
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10/01/2015
|
03/21/2021
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Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow
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L34372
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10/01/2015
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07/01/2020
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Magnetic Resonance Angiography (MRA)
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L34519
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10/01/2015
|
12/12/2021
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Molecular Pathology Procedures
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L34520
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10/01/2015
|
07/01/2020
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Psychological and Neuropsychological Tests
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L34521
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10/01/2015
|
01/08/2019
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Special EEG Tests
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L34522
|
10/01/2015
|
12/11/2022
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Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder
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L34859
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10/01/2015
|
10/01/2019
|
Nerve Conduction Studies and Electromyography
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L34912
|
10/01/2015
|
10/01/2019
|
Genetic Testing for Lynch Syndrome
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L34976
|
10/01/2015
|
07/11/2021
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Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
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L36035
|
10/01/2015
|
11/28/2019
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Spinal Cord Stimulation for Chronic Pain
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L36377
|
10/01/2015
|
01/08/2019
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Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities
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L36393
|
10/11/2015
|
10/01/2019
|
Controlled Substance Monitoring and Drugs of Abuse Testing
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L36499
|
04/11/2016
|
12/10/2020
|
BRCA1 and BRCA2 Genetic Testing
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L36767
|
10/31/2016
|
10/01/2019
|
Aortography and peripheral angiography
|
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L36773
|
11/07/2016
|
07/31/2019
|
Intensity Modulated Radiation Therapy (IMRT)
|
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L37166
|
12/07/2017
|
07/23/2020
|
Wound Care
|
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L37398
|
02/02/2018
|
11/28/2019
|
Electroretinography (ERG)
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L37561
|
02/02/2018
|
11/28/2019
|
Cystatin C Measurement
|
|
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L37564
|
03/01/2019
|
07/01/2019
|
Frequency of Hemodialysis
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L37798
|
03/18/2019
|
01/06/2020
|
4Kscore Test Algorithm
|
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|
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
|
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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
|
|
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L39073
|
12/12/2021
|
|
Pharmacogenomics Testing
|
|
|
L39084
|
01/30/2022
|
01/30/2022
|
Genetic Testing for Cardiovascular Disease
|
|
|
L39492
|
06/11/2023
|
|
Ambulatory Electrocardiograph (AECG) Monitoring
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