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

Palmetto GBA
North Carolina
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11501

Currently Active LCDs143
Draft LCDs28
Retired LCDs2
Currently Active Articles314
Retired Articles14

Currently Active LCDs

LCD
Effective
Date
Revision
Effective
Date
Title
CPT Codes Covered in LCD
L33420 10/01/2015 03/04/2021 Lab: Bladder/Urothelial Tumor Markers
L33423 10/01/2015 04/06/2023 Cardiac Computed Tomography & Angiography (CCTA)
L33428 10/01/2015 07/29/2021 Cosmetic and Reconstructive Surgery
L33445 10/01/2015 10/24/2019 Removal of Benign and Malignant Skin Lesions
L33456 10/01/2015 06/15/2023 Total Joint Arthroplasty
L33457 10/01/2015 03/23/2023 Cardiac Radionuclide Imaging
L33459 10/01/2015 10/10/2019 Computerized Axial Tomography (CT), Thorax
L33467 10/01/2015 05/11/2023 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
L34410 10/01/2015 06/10/2021 B-type Natriuretic Peptide (BNP) Testing
L34411 10/01/2015 05/20/2021 Blepharoplasty, Eyelid Surgery, and Brow Lift
L34413 10/01/2015 05/26/2022 Cataract Surgery
L34415 10/01/2015 08/28/2022 CT of the Abdomen and Pelvis
L34417 10/01/2015 08/17/2023 CT of the Head
L34419 10/01/2015 06/10/2021 Homocysteine Level, Serum
L34422 10/01/2015 07/06/2023 Infrared Coagulation (IRC) of Hemorrhoids
L34424 10/01/2015 10/24/2019 Magnetic Resonance Angiography
L34425 10/01/2015 09/09/2021 Magnetic Resonance Imaging of the Orbit, Face, and/or Neck
L34426 10/01/2015 07/15/2021 Ophthalmic Angiography (Fluorescein and Indocyanine Green)
L34427 10/01/2015 04/13/2023 Outpatient Occupational Therapy
L34428 10/01/2015 05/18/2023 Outpatient Physical Therapy
L34429 10/01/2015 12/08/2022 Outpatient Speech Language Pathology
L34430 10/01/2015 07/22/2021 Respiratory Therapy (Respiratory Care)
L34431 10/01/2015 08/12/2021 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
L34433 10/01/2015 07/27/2023 Somatosensory Testing
L34434 10/01/2015 08/14/2022 Upper Gastrointestinal Endoscopy and Visualization
L34454 10/01/2015 04/29/2021 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
L34512 10/01/2015 06/09/2022 Corneal Pachymetry
L34513 10/01/2015 08/10/2023 Lab: Flow Cytometry
L34549 10/01/2015 07/29/2021 Ambulance Services
L34551 10/01/2015 05/05/2022 One Day Stays for Chest Pain
L34552 10/01/2015 10/31/2019 Outpatient Observation Bed/Room Services
L34553 10/01/2015 10/07/2021 Stretta Procedure
L34554 10/01/2015 02/25/2021 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
L34575 10/01/2015 06/15/2023 Frequency of Hemodialysis
L34576 10/01/2015 09/08/2022 Laparoscopic Sleeve Gastrectomy for Severe Obesity
L34577 10/01/2015 11/07/2019 Retroperitoneal Ultrasound
L34578 10/01/2015 08/17/2023 Surface Electrical Stimulation in the Treatment of Dysphagia
L34580 10/01/2015 05/18/2023 Intravenous Immunoglobulin (IVIG)
L35025 10/01/2015 05/04/2023 MolDX: Molecular Diagnostic Tests (MDT)
L35026 10/01/2015 11/28/2019 Rituximab
L35048 10/01/2015 07/15/2021 Nerve Conduction Studies and Electromyography
L35073 10/01/2015 07/27/2023 MolDX: NRAS Genetic Testing
L35677 10/01/2015 08/05/2021 Infliximab
L35724 10/01/2015 10/08/2023 Urine Drug Testing
L35922 10/01/2015 12/15/2022 Lab: Special Histochemical Stains and Immunohistochemical Stains
L35974 10/01/2015 10/14/2021 MolDX: MGMT Promoter Methylation Analysis
L36044 10/05/2015 07/06/2023 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
L36089 10/01/2015 07/20/2023 MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L36125 10/01/2015 04/22/2021 MolDX: Breast Cancer Assay: Prosigna®
L36129 10/05/2015 04/22/2021 MolDX: Biomarkers in Cardiovascular Risk Assessment
L36427 01/25/2016 10/28/2021 Wireless Capsule Endoscopy
L36464 02/15/2016 08/24/2023 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
L36593 06/13/2016 03/16/2023 Polysomnography
L36665 10/10/2016 12/30/2021 ProMark® Risk Score
L36761 10/17/2016 07/27/2023 GlycoMark® Testing for Glycemic Control
L36763 11/21/2016 03/24/2022 4Kscore® Assay
L36854 03/13/2017 10/31/2019 MolDX: Percepta® Bronchial Genomic Classifier
L36912 03/06/2017 11/25/2021 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
L37022 07/10/2017 02/25/2021 Lab: Coenzyme Q10 (CoQ10)
L37031 07/10/2017 04/28/2022 BDX-XL2
L37033 07/10/2017 06/30/2022 MolDX: DecisionDx-UM (Uveal Melanoma)
L37176 06/12/2017 02/05/2023 White Cell Colony Stimulating Factors
L37260 09/26/2017 02/25/2021 MolDX: Prometheus IBD sgi Diagnostic® Policy
L37264 10/02/2017 07/04/2021 MolDX: EndoPredict Breast Cancer Gene Expression Test
L37379 09/18/2017 06/10/2021 Echocardiography
L37531 12/24/2018 06/23/2022 Micro-Invasive Glaucoma Surgery (MIGS)
L37581 12/03/2018 06/09/2022 Lab: Cystatin C Measurement
L37602 04/08/2019 07/13/2023 MDS FISH
L37632 01/29/2018 05/13/2021 Spinal Cord Stimulators for Chronic Pain
L37633 01/29/2018 08/06/2020 Partial Hospitalization Programs
L37638 01/29/2018 10/10/2019 Health and Behavior Assessment/Intervention
L37641 01/29/2018 06/23/2022 Continuous Peripheral Nerve Blocks (CPNB)
L37642 01/29/2018 07/29/2021 Nerve Blocks and Electrostimulation for Peripheral Neuropathy
L37643 01/29/2018 12/05/2019 Routine Foot Care
L37644 01/29/2018 03/10/2022 YAG Capsulotomy
L37725 12/03/2018 07/03/2022 MolDX: Melanoma Risk Stratification Molecular Testing
L37761 09/24/2018 08/13/2020 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 07/29/2021 Intraoperative Radiation Therapy
L37794 03/11/2019 10/28/2021 MolDX: Breast Cancer Index® (BCI) Gene Expression Test
L37826 05/06/2019 06/17/2021 Lumbar Artificial Disc Replacement
L37848 05/06/2019 09/09/2021 Lumbar Spinal Fusion
L37857 04/01/2019 06/29/2023 MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic Test
L37863 05/06/2019 04/20/2023 Voretigene Neparvovec-rzyl (Luxturna®)
L37870 04/08/2019 10/14/2021 MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer
L37873 05/06/2019 05/04/2023 Topical Oxygen Therapy
L38026 10/21/2019 03/17/2022 Corneal Hysteresis
L38033 10/28/2019 04/27/2023 Cervical Disc Replacement
L38043 02/03/2020 12/30/2021 MolDX: Plasma-Based Genomic Profiling in Solid Tumors
L38045 02/10/2020 06/08/2023 MolDX: Next-Generation Sequencing for Solid Tumors
L38047 02/10/2020 07/08/2021 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
L38051 02/10/2020 12/23/2021 MolDX: Pigmented Lesion Assay
L38238 06/14/2020 07/20/2023 MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer
L38240 10/25/2020 05/26/2022 MolDX: Blood Product Molecular Antigen Typing
L38274 05/31/2020 12/30/2021 MolDX: Repeat Germline Testing
L38276 06/21/2020 04/13/2023 Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
L38278 11/22/2020 08/14/2022 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease
L38292 11/08/2020 02/03/2022 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
L38294 07/26/2020 08/24/2023 MolDX: Pharmacogenomics Testing
L38549 12/27/2020 01/29/2023 Transurethral Waterjet Ablation of the Prostate
L38551 10/11/2020 05/26/2022 Transanal Endoscopic Surgery (TES)
L38566 07/25/2021 06/02/2022 MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells
L38568 06/06/2021 07/27/2023 MolDX: Molecular Testing for Solid Organ Allograft Rejection
L38576 07/18/2021 08/06/2023 MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
L38737 11/28/2021 07/20/2023 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
L38743 04/18/2021 05/26/2022 Implantable Continuous Glucose Monitors (I-CGM)
L38745 02/07/2021 03/23/2023 Platelet Rich Plasma
L38747 02/28/2021 Peroral Endoscopic Myotomy (POEM)
L38755 04/12/2021 Colon Capsule Endoscopy (CCE)
L38765 04/25/2021 05/18/2023 Facet Joint Interventions for Pain Management
L38769 02/07/2021 03/16/2023 Computed Tomography Cerebral Perfusion Analysis (CTP)
L38775 02/14/2021 Extracorporeal Shock Wave Therapy (ESWT)
L38779 12/26/2021 MolDX: Minimal Residual Disease Testing for Cancer
L38786 02/07/2021 Echocardiography for Myocardial Perfusion
L38792 02/07/2021 05/26/2022 Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza®)
L38966 07/03/2022 MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
L38970 12/05/2021 Advance Care Planning
L38985 07/03/2022 07/27/2023 MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer
L38988 04/17/2022 06/09/2022 MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
L38994 12/05/2021 09/14/2023 Epidural Steroid Injections for Pain Management
L39025 07/17/2022 Minimally Invasive Surgical (MIS) Fusion of the Sacroiliac Joint (SIJ)
L39080 12/12/2021 Cardiac Resynchronization Therapy (CRT)
L39086 02/13/2022 05/05/2022 Treatment of Males with Low Testosterone
L39121 04/03/2022 04/03/2022 Treatment of Varicose Veins of the Lower Extremities
L39128 04/30/2023 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
L39237 07/24/2022 Erythropoiesis Stimulating Agents
L39256 05/14/2023 MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia
L39258 03/05/2023 Surgical Treatment of Nails
L39260 08/21/2022 Hyaluronic Acid Injections for Knee Osteoarthritis
L39266 08/28/2022 Cognitive Assessment and Care Plan Service
L39268 09/18/2022 Bone Mass Measurement
L39270 09/04/2022 Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin
L39345 08/06/2023 MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma
L39385 02/12/2023 Near-Infrared Spectroscopy in Wound and Flap Management
L39387 02/19/2023 Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
L39391 01/29/2023 07/27/2023 Vitamin D Assay Testing
L39400 01/22/2023 Magnesium
L39402 03/19/2023 Sacroiliac Joint Injections and Procedures
L39420 03/05/2023 Thermal Destruction of the Intraosseous Basivertebral Nerve (BVN) for Vertebrogenic Lower Back Pain
L39424 10/15/2023 MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis
L39543 11/05/2023 Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence



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