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

Palmetto GBA
North Carolina
MAC A
11501

Currently Active LCDs124
Draft LCDs37
Retired LCDs4
Currently Active Articles253
Retired Articles5

Currently Active LCDs

All LCDs Laboratory LCDs Radiology LCDs
LCD
Effective
Date
Revision
Effective
Date
Title
CPT Codes Covered in LCD
L33420 10/01/2015 10/31/2019 Lab: Bladder/Urothelial Tumor Markers
L33423 10/01/2015 10/24/2019 Cardiac Computed Tomography & Angiography (CCTA)
L33428 10/01/2015 10/24/2019 Cosmetic and Reconstructive Surgery
L33445 10/01/2015 10/24/2019 Removal of Benign and Malignant Skin Lesions
L33456 10/01/2015 10/24/2019 Total Joint Arthroplasty
L33457 10/01/2015 10/10/2019 Cardiac Radionuclide Imaging
L33459 10/01/2015 10/10/2019 Computerized Axial Tomography (CT), Thorax
L33467 10/01/2015 10/24/2019 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
L34410 10/01/2015 10/10/2019 B-type Natriuretic Peptide (BNP) Testing
L34411 10/01/2015 10/10/2019 Blepharoplasty, Eyelid Surgery, and Brow Lift
L34413 10/01/2015 10/10/2019 Cataract Surgery
L34415 10/01/2015 10/10/2019 CT of the Abdomen and Pelvis
L34417 10/01/2015 10/10/2019 CT of the Head
L34419 10/01/2015 10/24/2019 Homocysteine Level, Serum
L34422 10/01/2015 10/24/2019 Infrared Coagulation (IRC) of Hemorrhoids
L34424 10/01/2015 10/24/2019 Magnetic Resonance Angiography
L34425 10/01/2015 10/24/2019 Magnetic Resonance Imaging of the Orbit, Face, and/or Neck
L34426 10/01/2015 10/24/2019 Ophthalmic Angiography (Fluorescein and Indocyanine Green)
L34427 10/01/2015 11/14/2019 Outpatient Occupational Therapy
L34428 10/01/2015 11/14/2019 Outpatient Physical Therapy
L34429 10/01/2015 06/25/2020 Outpatient Speech Language Pathology
L34430 10/01/2015 10/24/2019 Respiratory Therapy (Respiratory Care)
L34431 10/01/2015 10/24/2019 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
L34433 10/01/2015 10/24/2019 Somatosensory Testing
L34434 10/01/2015 10/24/2019 Upper Gastrointestinal Endoscopy and Visualization
L34454 10/01/2015 10/10/2019 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
L34512 10/01/2015 06/18/2020 Corneal Pachymetry
L34513 10/01/2015 10/31/2019 Lab: Flow Cytometry
L34549 10/01/2015 10/10/2019 Ambulance Services
L34551 10/01/2015 02/20/2020 One Day Stays for Chest Pain
L34552 10/01/2015 10/31/2019 Outpatient Observation Bed/Room Services
L34553 10/01/2015 10/24/2019 Stretta Procedure
L34554 10/01/2015 10/31/2019 In Vitro Chemosensitivity & Chemoresistance Assays
L34570 10/01/2015 10/31/2019 Psychiatric Inpatient Hospitalization
L34573 10/01/2015 10/10/2019 Cardiac Event Detection
L34574 10/01/2015 10/10/2019 Dental Services
L34575 10/01/2015 10/01/2019 Frequency of Hemodialysis
L34576 10/01/2015 10/10/2019 Laparoscopic Sleeve Gastrectomy for Severe Obesity
L34577 10/01/2015 11/07/2019 Retroperitoneal Ultrasound
L34578 10/01/2015 11/21/2019 Surface Electrical Stimulation in the Treatment of Dysphagia
L34580 10/01/2015 10/10/2019 Intravenous Immunoglobulin (IVIG)
L35024 10/01/2015 12/05/2019 MolDX: Genetic Testing for Lynch Syndrome
L35025 10/01/2015 12/12/2019 MolDX: Molecular Diagnostic Tests (MDT)
L35026 10/01/2015 11/28/2019 Rituximab
L35048 10/01/2015 10/10/2019 Nerve Conduction Studies and Electromyography
L35071 10/01/2015 10/31/2019 MolDX: Circulating Tumor Cell Marker Assays
L35072 10/01/2015 10/24/2019 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
L35073 10/01/2015 11/07/2019 MolDX: NRAS Genetic Testing
L35632 10/01/2015 10/31/2019 MolDX: ConfirmMDx Epigenetic Molecular Assay
L35633 10/01/2015 10/31/2019 MolDX: GeneSight® Assay for Refractory Depression
L35677 10/01/2015 10/31/2019 Infliximab
L35724 10/01/2015 11/21/2019 Lab: Controlled Substance Monitoring and Drugs of Abuse Testing
L35868 10/01/2015 11/07/2019 MolDX: Decipher® Prostate Cancer Classifier Assay
L35869 10/01/2015 10/31/2019 MolDX: Prolaris™ Prostate Cancer Genomic Assay
L35922 10/01/2015 10/31/2019 Lab: Special Histochemical Stains and Immunohistochemical Stains
L35974 10/01/2015 11/21/2019 MolDX: MGMT Promoter Methylation Analysis
L36033 10/05/2015 10/31/2019 MolDX: HLA-B*15:02 Genetic Testing
L36044 10/05/2015 11/07/2019 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
L36074 10/01/2015 10/31/2019 MolDX: Molecular RBC Phenotyping
L36082 10/05/2015 12/04/2019 MolDX: BRCA1 and BRCA2 Genetic Testing
L36089 10/01/2015 10/31/2019 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L36125 10/01/2015 11/21/2019 MolDX: Breast Cancer Assay: Prosigna
L36129 10/05/2015 11/07/2019 MolDX: Biomarkers in Cardiovascular Risk Assessment
L36153 10/01/2015 10/31/2019 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
L36427 01/25/2016 10/24/2019 Wireless Capsule Endoscopy
L36464 02/15/2016 10/31/2019 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
L36471 02/15/2016 10/10/2019 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
L36593 06/13/2016 10/24/2019 Polysomnography
L36665 10/10/2016 11/07/2019 MolDX: ProMark Risk Score
L36761 10/17/2016 10/31/2019 GlycoMark Testing for Glycemic Control
L36763 11/21/2016 10/31/2019 MolDX: 4Kscore Assay
L36827 03/13/2017 10/31/2019 MolDX: APC and MUTYH Gene Testing
L36854 03/13/2017 10/31/2019 MolDX: Percepta® Bronchial Genomic Classifier
L36912 03/06/2017 10/31/2019 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
L37022 07/10/2017 06/01/2020 Lab: Coenzyme Q10 (CoQ10)
L37031 07/10/2017 10/24/2019 MolDX: BDX-XL2
L37033 07/10/2017 10/31/2019 MolDX: DecisionDx-UM (Uveal Melanoma)
L37043 07/10/2017 10/31/2019 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
L37176 06/12/2017 10/10/2019 White Cell Colony Stimulating Factors
L37260 09/26/2017 11/07/2019 MolDX: Prometheus IBD sgi Diagnostic Policy
L37262 10/02/2017 10/31/2019 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
L37264 10/02/2017 11/07/2019 MolDX: EndoPredict Breast Cancer Gene Expression Test
L37266 10/02/2017 10/31/2019 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test
L37379 09/18/2017 10/10/2019 Echocardiography
L37531 12/24/2018 02/10/2020 Micro-Invasive Glaucoma Surgery (MIGS)
L37581 12/03/2018 11/07/2019 MolDX: Cystatin C Measurement
L37602 04/08/2019 10/31/2019 MolDX: MDS FISH
L37612 11/05/2018 11/21/2019 MolDX: Corus® CAD Assay
L37632 01/29/2018 10/24/2019 Spinal Cord Stimulators for Chronic Pain
L37633 01/29/2018 10/24/2019 Partial Hospitalization Programs
L37638 01/29/2018 10/10/2019 Health and Behavior Assessment/Intervention
L37641 01/29/2018 10/10/2019 Continuous Peripheral Nerve Blocks (CPNB)
L37642 01/29/2018 10/10/2019 Nerve Blocks and Electrostimulation for Peripheral Neuropathy
L37643 01/29/2018 12/05/2019 Routine Foot Care
L37644 01/29/2018 05/28/2020 YAG Capsulotomy
L37701 12/10/2018 11/21/2019 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)
L37709 12/10/2018 10/31/2019 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs)
L37713 11/12/2018 11/02/2019 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
L37725 12/03/2018 08/29/2019 MolDX: DecisionDx-Melanoma
L37761 09/24/2018 02/10/2020 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor
L37774 11/19/2018 10/24/2019 Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication
L37779 09/24/2018 10/10/2019 Intraoperative Radiation Therapy
L37785 04/01/2019 11/14/2019 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease
L37794 03/11/2019 10/31/2019 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test
L37826 05/06/2019 10/24/2019 Lumbar Artificial Disc Replacement
L37848 05/06/2019 10/24/2019 Lumbar Spinal Fusion
L37857 04/01/2019 10/24/2019 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
L37859 04/29/2019 10/31/2019 MolDX: myPath Melanoma Assay
L37863 05/06/2019 05/28/2020 Voretigene Neparvovec-rzyl (Luxturna®)
L37870 04/08/2019 03/05/2020 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer
L37873 05/06/2019 10/24/2019 Topical Oxygen Therapy
L38026 10/21/2019 02/13/2020 Corneal Hysteresis
L38029 01/06/2020 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease
L38033 10/28/2019 10/28/2019 Cervical Disc Replacement
L38039 11/25/2019 MolDX: TruGraf Blood Gene Expression Test
L38041 02/03/2020 MolDX: Prospera™
L38043 02/03/2020 03/05/2020 MolDX: Plasma-Based Genomic Profiling in Solid Tumors
L38045 02/10/2020 03/05/2020 MolDX: Next-Generation Sequencing for Solid Tumors
L38047 02/10/2020 03/05/2020 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
L38051 02/10/2020 MolDX: Pigmented Lesion Assay
L38238 06/14/2020 MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer
L38274 05/31/2020 MolDX: Repeat Germline Testing
L38276 06/21/2020 Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
L38294 07/26/2020 MolDX: Pharmacogenomics Testing



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