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Currently Active LCDs124
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Currently Active Articles252
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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
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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