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2017 ICD-10 Diagnosis Code Set Loaded     


4/3/2017 NCD Edits Loaded     


2017 Lab Fee Schedule     


2017-B DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for Q2/2017     


2017 April ASC Fee Schedule Updated     


April 2017 ASP Drug Pricing Updated     


Q2 2017 CCI Edits Loaded     


Q2 2017 MUE Edits Loaded     


LCD Database Current Through 06/19/2017     

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Laboratory Fee Schedule

2017
2016

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2017
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ASP Drug Pricing Files




New Future Effective LCD Policy Report for all Medicare Contractors


Click here for a report of currently active policies with upcoming revisions.

LCDTitle Effective Date
L36095 MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC
L36132 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Noridian Healthcare Solutions, LLC
L36140 Bioimpedance Spectroscopy (BIS) Devices for the Detection and Management of Lymphedema-National Government Services, Inc.
L36146 MolDX: HLA-B*15:02 Genetic Testing-Noridian Healthcare Solutions, LLC
L36176 MolDX: NSCLC, Comprehensive Genomic Profile Testing-Noridian Healthcare Solutions, LLC
L36181 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Noridian Healthcare Solutions, LLC
L36189 MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC
L36195 MolDX: NSCLC, Comprehensive Genomic Profile Testing-Noridian Healthcare Solutions, LLC
L36264 Lower Limb Prostheses-NHIC, Corp.
L36295 Surgical Dressings-NHIC, Corp.
L36317 MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC
L36319 MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC
L36359 MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC
L36383 MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC
L36432 Facet Joint Injections-Novitas Solutions, Inc.
L36447 Nerve Blockade for Treatment of Chronic Pain and Neuropathy -Novitas Solutions, Inc.
L36558 Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC
L36580 Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC
L36685 Hyperbaric Oxygen (HBO) Therapy -Noridian Healthcare Solutions, LLC
L36687 Intraoperative Neurophysiological Testing-Noridian Healthcare Solutions, LLC
L36695 Hyperbaric Oxygen (HBO) Therapy -Noridian Healthcare Solutions, LLC
L36697 Intraoperative Neurophysiological Testing-Noridian Healthcare Solutions, LLC
L36710 Intensity Modulated Radiation Therapy (IMRT)-Novitas Solutions, Inc.
L36836 Chest X-Ray Policy-Noridian Healthcare Solutions, LLC
L36840 Chest X-Ray Policy-Noridian Healthcare Solutions, LLC
L36845 Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC
L36848 Diagnostic and Therapeutic Colonoscopy -Noridian Healthcare Solutions, LLC
L36856 Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC
L36863 GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC
L36865 GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC
L36867 Diagnostic and Therapeutic Colonoscopy -Noridian Healthcare Solutions, LLC
L36870 Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC
L36874 Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC
L36887 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC
L36888 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC
L36903 Cognitive Rehabilitation-National Government Services, Inc.
L36936 Laparoscopic Sleeve Gastrectomy for Severe Obesity-Palmetto GBA
L36953 Noncovered Services other than CPT® Category III Noncovered Services-Palmetto GBA
L36961 Vascular Endothelial Growth Factor Inhibitors for the Treatment of Ophthalmological Diseases -First Coast Service Options, Inc.
L36970 Non-coronary and non-cerebrovascular angioplasty with or without stent placement-First Coast Service Options, Inc.
L37000 MolDX: MGMT Promoter Methylation Analysis-Wisconsin Physicians Service Insurance Corporation
L37002 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Wisconsin Physicians Service Insurance Corporation
L37004 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Wisconsin Physicians Service Insurance Corporation
L37006 Infectious Disease Molecular Diagnostic Testing-Wisconsin Physicians Service Insurance Corporation
L37008 MolDX: Chromosome 1p/19q Deletion Analysis-Wisconsin Physicians Service Insurance Corporation
L37010 MolDX-CDD: ProMark Risk Score-Wisconsin Physicians Service Insurance Corporation
L37012 MolDX: 4Kscore Assay-Wisconsin Physicians Service Insurance Corporation
L37014 Visual Electrophysiology Testing-Wisconsin Physicians Service Insurance Corporation
L37018 Plastic Surgery-Noridian Healthcare Solutions, LLC
L37019 Plastic Surgery-Noridian Healthcare Solutions, LLC
L37021 Coenzyme Q10 (CoQ10)-Palmetto GBA
L37023 MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-Palmetto GBA
L37025 Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC
L37026 Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC
L37030 MolDX: Xpresys Lung -Palmetto GBA
L37032 MolDX: DecisionDx-UM (Uveal Melanoma)-Palmetto GBA
L37034 MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Palmetto GBA
L37038 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-Palmetto GBA
L37040 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-Palmetto GBA
L37042 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Palmetto GBA
L37044 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-Palmetto GBA
L37053 MolDX: Xpresys Lung -Noridian Healthcare Solutions, LLC
L37059 MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Noridian Healthcare Solutions, LLC
L37061 MolDX: Xpresys Lung -Noridian Healthcare Solutions, LLC
L37063 MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Noridian Healthcare Solutions, LLC
L37065 Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC
L37067 Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC
L37069 MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC
L37071 MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC
L37077 Genomic Sequence Analysis Panels in the Treatment of Myelodysplastic Syndromes (MDS)-National Government Services, Inc.
L37079 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC
L37081 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC
L37085 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Noridian Healthcare Solutions, LLC
L37087 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Noridian Healthcare Solutions, LLC
L37089 MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-Noridian Healthcare Solutions, LLC
L37091 MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-Noridian Healthcare Solutions, LLC
L37100 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-Noridian Healthcare Solutions, LLC
L37102 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-Noridian Healthcare Solutions, LLC
L37104 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-Noridian Healthcare Solutions, LLC
L37106 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-Noridian Healthcare Solutions, LLC
L37108 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-Noridian Healthcare Solutions, LLC
L37110 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-Noridian Healthcare Solutions, LLC
L37113 Visual Electrophysiology Testing -Noridian Healthcare Solutions, LLC
L37115 Visual Electrophysiology Testing -Noridian Healthcare Solutions, LLC
L37119 4Kscore Assay-Noridian Healthcare Solutions, LLC
L37121 4Kscore Assay-Noridian Healthcare Solutions, LLC
L37123 Endoscopic Treatment of GERD-National Government Services, Inc.
L37125 Coenzyme Q10 (CoQ10)-CGS Administrators, LLC
L37127 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-CGS Administrators, LLC
L37129 MolDX: DecisionDx-UM (Uveal Melanoma)-CGS Administrators, LLC
L37131 MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-CGS Administrators, LLC
L37133 MolDX: Xpresys Lung -CGS Administrators, LLC
L37135 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-CGS Administrators, LLC
L37137 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-CGS Administrators, LLC
L37139 MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-CGS Administrators, LLC
L37141 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-CGS Administrators, LLC
L37143 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-CGS Administrators, LLC
L37144 Retroperitoneal Ultrasound-Palmetto GBA
L37145 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-Palmetto GBA
L37146 Magnetic Resonance Angiography-Palmetto GBA
L37147 Allergy Skin Testing-Palmetto GBA
L37148 Transesophageal Echocardiography (TEE)-Palmetto GBA
L37149 Wireless Capsule Endoscopy-Palmetto GBA
L37150 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-Palmetto GBA
L37151 Virtual Colonoscopy (CT Colonography)-Palmetto GBA
L37152 CT of the Head-Palmetto GBA
L37155 Somatosensory Testing-Palmetto GBA
L37156 Octreotide Acetate for Injectable Suspension (Sandostatin LAR depot)-Palmetto GBA
L37157 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder -Novitas Solutions, Inc.
L37158 Scanning Computerized Ophthalmic Diagnostic Imaging-Novitas Solutions, Inc.
L37159 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-First Coast Service Options, Inc.
L37162 Wound Care-Novitas Solutions, Inc.
L37165 Wound Care-First Coast Service Options, Inc.
L37169 Treatment of Varicose Veins of the Lower Extremities-Novitas Solutions, Inc.
L37174 Noncovered Services-First Coast Service Options, Inc.
L37175 White Cell Colony Stimulating Factors-Palmetto GBA
L37192 Coenzyme Q10 Testing-Wisconsin Physicians Service Insurance Corporation
L37194 MolDX-CDD: Percepta© Bronchial Genomic Classifier-Wisconsin Physicians Service Insurance Corporation
L37198 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Wisconsin Physicians Service Insurance Corporation
L37200 MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-Wisconsin Physicians Service Insurance Corporation
L37202 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-Wisconsin Physicians Service Insurance Corporation
L37204 Chemotherapy Drugs and their Adjuncts-Wisconsin Physicians Service Insurance Corporation
L37209 MolDX: Decision Dx-UM (Uveal Melanoma)-Wisconsin Physicians Service Insurance Corporation
L37215 MolDX: Xpresys Lung-Wisconsin Physicians Service Insurance Corporation
L37217 MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Wisconsin Physicians Service Insurance Corporation
L37219 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-Wisconsin Physicians Service Insurance Corporation
L37221 MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-Wisconsin Physicians Service Insurance Corporation
L37223 MolDX: APC and MUTYH Gene Testing-Wisconsin Physicians Service Insurance Corporation
L37225 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Wisconsin Physicians Service Insurance Corporation
L37227 Wound Care-Wisconsin Physicians Service Insurance Corporation
L37240 Chiropractic Services-Noridian Healthcare Solutions, LLC
L37243 Micro-Invasive Glaucoma Surgery (MIGS) -National Government Services, Inc.
L37245 Varicose Veins of the Lower Extremity, Treatment of-National Government Services, Inc.
L37246 Noninvasive Peripheral Venous Studies-Noridian Healthcare Solutions, LLC
L37247 Chiropractic Services-Noridian Healthcare Solutions, LLC
L37249 MolDX: APC and MUTYH Gene Testing -CGS Administrators, LLC
L37250 MolDX-CDD: Percepta© Bronchial Genomic Classifier-CGS Administrators, LLC
L37253 Chiropractic Services-CGS Administrators, LLC
L37257 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Palmetto GBA
L37259 MolDX: Prometheus IBD sgi Diagnostic Policy-Palmetto GBA
L37261 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Palmetto GBA
L37263 MolDX: EndoPredict Breast Cancer Gene Expression Test-Palmetto GBA
L37265 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Palmetto GBA
L37268 Electrocardiograms-Noridian Healthcare Solutions, LLC
L37270 Monitored Anesthesia Care (MAC)-Noridian Healthcare Solutions, LLC
L37271 Monitored Anesthesia Care (MAC)-Noridian Healthcare Solutions, LLC
L37279 Lumbar MRI-Noridian Healthcare Solutions, LLC
L37280 Lumbar MRI-Noridian Healthcare Solutions, LLC
L37282 Electrocardiograms-Noridian Healthcare Solutions, LLC
L37284 MRI and CT Scans of the Head and Neck-Noridian Healthcare Solutions, LLC
L37285 Pulmonary Function Testing-Noridian Healthcare Solutions, LLC
L37286 Peripheral Nerve Stimulation-Noridian Healthcare Solutions, LLC
L37287 Respiratory Care (Respiratory Therapy )-Noridian Healthcare Solutions, LLC
L37288 Pulmonary Function Testing-Noridian Healthcare Solutions, LLC
L37290 Noninvasive Peripheral Venous Studies-Noridian Healthcare Solutions, LLC
L37292 Respiratory Care (Respiratory Therapy )-Noridian Healthcare Solutions, LLC
L37294 MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC
L37298 MolDX: Prometheus IBD sgi Diagnostic Policy-Noridian Healthcare Solutions, LLC
L37300 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Noridian Healthcare Solutions, LLC
L37302 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Noridian Healthcare Solutions, LLC
L37304 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Noridian Healthcare Solutions, LLC
L37306 Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries-Noridian Healthcare Solutions, LLC
L37308 Duplex Scan Of Lower Extremity Arteries-Noridian Healthcare Solutions, LLC
L37310 MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC
L37312 MolDX: Prometheus IBD sgi Diagnostic Policy-Noridian Healthcare Solutions, LLC
L37314 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Noridian Healthcare Solutions, LLC
L37316 Noninvasive Extracranial Arterial Studies-Noridian Healthcare Solutions, LLC
L37318 Transcranial Doppler Studies-Noridian Healthcare Solutions, LLC
L37320 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Noridian Healthcare Solutions, LLC
L37324 Allergy Testing-Noridian Healthcare Solutions, LLC
L37327 Medicine: Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Cahaba Government Benefit Administrators®, LLC
L37329 MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Palmetto GBA
L37331 Medicine: Visual Electrophysiology Testing-Cahaba Government Benefit Administrators®, LLC
L37333 Medicine: Somatosensory Testing-Cahaba Government Benefit Administrators®, LLC
L37335 Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries-Noridian Healthcare Solutions, LLC
L37337 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-Palmetto GBA
L37339 Duplex Scan Of Lower Extremity Arteries-Noridian Healthcare Solutions, LLC
L37341 Allergy Testing-Noridian Healthcare Solutions, LLC
L37343 Noninvasive Extracranial Arterial Studies-Noridian Healthcare Solutions, LLC
L37345 Transcranial Doppler Studies-Noridian Healthcare Solutions, LLC
L37347 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-CGS Administrators, LLC
L37349 MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Noridian Healthcare Solutions, LLC
L37351 MolDX: Prometheus IBD sgi Diagnostic Policy-CGS Administrators, LLC
L37353 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-CGS Administrators, LLC
L37355 MolDX: EndoPredict Breast Cancer Gene Expression Test-CGS Administrators, LLC
L37357 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Noridian Healthcare Solutions, LLC
L37359 Peripheral Nerve Stimulation-Noridian Healthcare Solutions, LLC
L37361 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-CGS Administrators, LLC
L37363 MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -CGS Administrators, LLC
L37365 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-CGS Administrators, LLC
L37367 MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Noridian Healthcare Solutions, LLC
L37369 Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography-Novitas Solutions, Inc.
L37370 Electroretinography (ERG)-Novitas Solutions, Inc.
L37372 MRI and CT Scans of the Head and Neck-Noridian Healthcare Solutions, LLC
L37374 Reflectance Confocal Microscopy-Novitas Solutions, Inc.
L37376 Cosmetic and Reconstructive Surgery-Palmetto GBA
L37377 Cardiac Computed Tomography & Angiography (CCTA)-Palmetto GBA
L37378 Echocardiography -Palmetto GBA
L37380 Non-Covered Category III CPT Codes-Palmetto GBA
L37386 Chiropractic Services-Palmetto GBA
L37388 Vertebroplasty/Kyphoplasty-Palmetto GBA
L37397 Electroretinography (ERG)-First Coast Service Options, Inc.
L37403 Lower Extremity Revascularization -First Coast Service Options, Inc.
L32553 Allergy Immunotherapy-CGS Administrators, LLC 10/01/2015
L33252 Psychiatric Diagnostic Evaluation and Psychotherapy Services-First Coast Service Options, Inc. 10/01/2015
L33256 3D Interpretation and Reporting of Imaging Studies-First Coast Service Options, Inc. 10/01/2015
L33257 Abatacept-First Coast Service Options, Inc. 10/01/2015
L33261 Allergy Testing-First Coast Service Options, Inc. 10/01/2015
L33262 Amifostine (Ethyol ®)-First Coast Service Options, Inc. 10/01/2015
L33263 Anorectal Manometry and EMG of the Urinary and Anal Sphincters-First Coast Service Options, Inc. 10/01/2015
L33266 Azacitidine (Vidaza®)-First Coast Service Options, Inc. 10/01/2015
L33267 B-Type Natriuretic Peptide (BNP)-First Coast Service Options, Inc. 10/01/2015
L33268 Bendamustine hydrochloride (Treanda®, Bendeka™)-First Coast Service Options, Inc. 10/01/2015
L33270 Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications-First Coast Service Options, Inc. 10/01/2015
L33271 Biventricular Pacing/ Cardiac Resynchronization Therapy-First Coast Service Options, Inc. 10/01/2015
L33272 Bone and/or Joint Imaging-First Coast Service Options, Inc. 10/01/2015
L33273 Bortezomib (Velcade®)-First Coast Service Options, Inc. 10/01/2015
L33274 Botulinum Toxins-First Coast Service Options, Inc. 10/01/2015
L33275 Carboplatin (Paraplatin®, Paraplatin-AQ®)-First Coast Service Options, Inc. 10/01/2015
L33278 Cetuximab (Erbitux®)-First Coast Service Options, Inc. 10/01/2015
L33279 Circulating Tumor Cell Testing-First Coast Service Options, Inc. 10/01/2015
L33280 Collagenase clostridium histolyticum (Xiaflex ®)-First Coast Service Options, Inc. 10/01/2015
L33282 Computed Tomographic Angiography of the Chest, Heart and Coronary Arteries-First Coast Service Options, Inc. 10/01/2015
L33283 Computed Tomographic Colonography-First Coast Service Options, Inc. 10/01/2015
L33284 Computed Tomography of the Abdomen and Pelvis-First Coast Service Options, Inc. 10/01/2015
L33285 Computed Tomography of the Thorax-First Coast Service Options, Inc. 10/01/2015
L33296 Noncovered Procedures - Endoscopic Treatment of Gastroesophageal Reflux Disease (GERD)-First Coast Service Options, Inc. 10/01/2015
L33312 Wheelchair Seating-Noridian Administrative Services 10/01/2015
L33316 Dialysis (AV fistula and graft) Vascular Access Maintenance-First Coast Service Options, Inc. 10/01/2015
L33317 External Breast Prostheses-Noridian Administrative Services 10/01/2015
L33318 Knee Orthoses-Noridian Administrative Services 10/01/2015
L33369 Therapeutic Shoes for Persons with Diabetes-Noridian Administrative Services 10/01/2015
L33370 Nebulizers-Noridian Administrative Services 10/01/2015
L33377 Implantable Miniature Telescope (IMT)-First Coast Service Options, Inc. 10/01/2015
L33379 Intraoperative Neurophysiology Monitoring-First Coast Service Options, Inc. 10/01/2015
L33380 Long-Term Wearable Electrocardiographic Monitoring (WEM)-First Coast Service Options, Inc. 10/01/2015
L33381 Low Density Lipoprotein (LDL) Apheresis-First Coast Service Options, Inc. 10/01/2015
L33382 Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions-First Coast Service Options, Inc. 10/01/2015
L33383 Non- Emergency Ground Ambulance Services-First Coast Service Options, Inc. 10/01/2015
L33391 Biologic Products for Wound Treatment and Surgical Interventions-National Government Services, Inc. 10/01/2015
L33392 Category III CPT® Codes-National Government Services, Inc. 10/01/2015
L33393 Hospice - Determining Terminal Status-National Government Services, Inc. 10/01/2015
L33394 Drugs and Biologicals, Coverage of, for Label and Off-Label Uses-National Government Services, Inc. 10/01/2015
L33396 Posterior Tibial Nerve Stimulation for Voiding Dysfunction-National Government Services, Inc. 10/01/2015
L33398 Transcranial Magnetic Stimulation-National Government Services, Inc. 10/01/2015
L33399 EEG – 24 Hour Monitoring-National Government Services, Inc. 10/01/2015
L33405 Polysomnography and Sleep Testing-First Coast Service Options, Inc. 10/01/2015
L33406 Posterior Tibial Nerve Stimulation (PTNS)-First Coast Service Options, Inc. 10/01/2015
L33407 Ranibizumab (Lucentis ®)-First Coast Service Options, Inc. 10/01/2015
L33410 Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-First Coast Service Options, Inc. 10/01/2015
L33411 Surgical Management of Morbid Obesity-First Coast Service Options, Inc. 10/01/2015
L33412 Testosterone pellets (Testopel®)-First Coast Service Options, Inc. 10/01/2015
L33413 Therapy and Rehabilitation Services-First Coast Service Options, Inc. 10/01/2015
L33414 Topical Photosensitizers used with PDT for Actinic Keratoses and Certain Skin Cancers-First Coast Service Options, Inc. 10/01/2015
L33416 3D Interpretation and Reporting of Imaging Studies-Palmetto GBA 10/01/2015
L33417 Allergy Skin Testing-Palmetto GBA 10/01/2015
L33418 Assays for Vitamins and Metabolic Function-Palmetto GBA 10/01/2015
L33420 Bladder/Urothelial Tumor Markers-Palmetto GBA 10/01/2015
L33422 Brain Natriuretic Peptide (BNP) Level-Palmetto GBA 10/01/2015
L33423 Cardiac Computed Tomography & Angiography (CCTA)-Palmetto GBA 10/01/2015
L33428 Cosmetic and Reconstructive Surgery-Palmetto GBA 10/01/2015
L33431 HbA1c-Palmetto GBA 10/01/2015
L33432 Hyaluronate Polymers-Palmetto GBA 10/01/2015
L33433 Infectious Disease Molecular Diagnostic Testing-Palmetto GBA 10/01/2015
L33434 K-ras Testing Required before Epidermal Growth Factor Receptor Antibody Use in Colorectal Cancer-Palmetto GBA 10/01/2015
L33436 Mohs Micrographic Surgery (MMS)-Palmetto GBA 10/01/2015
L33438 Octreotide Acetate for Injectable Suspension (Sandostatin LAR depot)-Palmetto GBA 10/01/2015
L33443 Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Palmetto GBA 10/01/2015
L33444 Pulmonary Stress Testing-Palmetto GBA 10/01/2015
L33445 Removal of Benign and Malignant Skin Lesions-Palmetto GBA 10/01/2015
L33446 Respiratory Therapy and Oximetry Services-Palmetto GBA 10/01/2015
L33447 Special Electroencephalography-Palmetto GBA 10/01/2015
L33448 Stress Echocardiography-Palmetto GBA 10/01/2015
L33449 Swallowing Studies for Dysphagia-Palmetto GBA 10/01/2015
L33452 Virtual Colonoscopy (CT Colonography)-Palmetto GBA 10/01/2015
L33454 Varicose Veins of the Lower Extremities-Palmetto GBA 10/01/2015
L33455 Wireless Gastrointestinal Motility Monitoring Systems-Palmetto GBA 10/01/2015
L33456 Total Joint Arthroplasty-Palmetto GBA 10/01/2015
L33457 Cardiac Radionuclide Imaging-Palmetto GBA 10/01/2015
L33458 Chemodenervation-Palmetto GBA 10/01/2015
L33459 Computerized Axial Tomography (CT), Thorax-Palmetto GBA 10/01/2015
L33461 Implantable Infusion Pump-Palmetto GBA 10/01/2015
L33464 MRI of a Joint-Palmetto GBA 10/01/2015
L33467 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography-Palmetto GBA 10/01/2015
L33468 Oral Maxillofacial Prosthesis-Palmetto GBA 10/01/2015
L33471 Transesophageal Echocardiography (TEE)-Palmetto GBA 10/01/2015
L33472 Transthoracic Echocardiography (TTE)-Palmetto GBA 10/01/2015
L33473 Vertebroplasty/Vertebral Augmentation-Palmetto GBA 10/01/2015
L33504 Intravitreal Bevacizumab (Avastin®)-First Coast Service Options, Inc. 10/01/2015
L33538 Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinomas of the Skin-First Coast Service Options, Inc. 10/01/2015
L33556 Vitamin D Assay Testing-National Government Services, Inc. 10/01/2015
L33557 Cardiac Catheterization and Coronary Angiography-National Government Services, Inc. 10/01/2015
L33558 Cataract Extraction-National Government Services, Inc. 10/01/2015
L33559 Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)-National Government Services, Inc. 10/01/2015
L33560 Cardiovascular Nuclear Medicine-National Government Services, Inc. 10/01/2015
L33562 Computed Tomographic (CT) Colonography for Diagnostic Uses-National Government Services, Inc. 10/01/2015
L33563 Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures-National Government Services, Inc. 10/01/2015
L33566 Wound Debridement Services-First Coast Service Options, Inc. 10/01/2015
L33567 Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)-National Government Services, Inc. 10/01/2015
L33569 Vertebroplasty and Vertebral Augmentation (Percutaneous)-National Government Services, Inc. 10/01/2015
L33571 Destruction of Internal Hemorrhoid(s) by Infrared Coagulation (IRC)-First Coast Service Options, Inc. 10/01/2015
L33573 B-type Natriuretic Peptide (BNP) Testing-National Government Services, Inc. 10/01/2015
L33574 Visual Fields Testing-National Government Services, Inc. 10/01/2015
L33575 Varicose Veins of the Lower Extremity, Treatment of-National Government Services, Inc. 10/01/2015
L33576 Urodynamics-National Government Services, Inc. 10/01/2015
L33577 Transthoracic Echocardiography (TTE)-National Government Services, Inc. 10/01/2015
L33578 Transrectal Ultrasound-National Government Services, Inc. 10/01/2015
L33579 Transesophageal Echocardiography (TEE)-National Government Services, Inc. 10/01/2015
L33580 Speech-Language Pathology-National Government Services, Inc. 10/01/2015
L33583 Diagnostic and Therapeutic Esophagogastroduodenoscopy-First Coast Service Options, Inc. 10/01/2015
L33584 Implantable Miniature Telescope (IMT)-National Government Services, Inc. 10/01/2015
L33585 Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography-National Government Services, Inc. 10/01/2015
L33586 Gene Expression Profiling Panel for use in the Management of Breast Cancer Treatment-First Coast Service Options, Inc. 10/01/2015
L33588 Combined Ovarian Cancer Biomarker Tests-National Government Services, Inc. 10/01/2015
L33591 RAST Type Tests-National Government Services, Inc. 10/01/2015
L33593 Implantable Infusion Pump for the Treatment of Chronic Intractable Pain-First Coast Service Options, Inc. 10/01/2015
L33594 Manipulation Under Anesthesia (MUA)-First Coast Service Options, Inc. 10/01/2015
L33595 Monitored Anesthesia Care (MAC) for Certain Interventional Pain Management Services-First Coast Service Options, Inc. 10/01/2015
L33596 Qutenza® (capsaicin) 8% patch-First Coast Service Options, Inc. 10/01/2015
L33600 Sinus X-ray(s)-First Coast Service Options, Inc. 10/01/2015
L33609 Autonomic Function Tests-First Coast Service Options, Inc. 10/01/2015
L33610 Intravenous Immune Globulin-Noridian Administrative Services 10/01/2015
L33611 Oral Appliances for Obstructive Sleep Apnea-Noridian Administrative Services 10/01/2015
L33612 Suction Pumps-Noridian Administrative Services 10/01/2015
L33613 Chiropractic Services-National Government Services, Inc. 10/01/2015
L33614 Debridement Services-National Government Services, Inc. 10/01/2015
L33615 Biofeedback-First Coast Service Options, Inc. 10/01/2015
L33616 Osteopathic Manipulative Treatment-National Government Services, Inc. 10/01/2015
L33617 Erythropoiesis Stimulating Agents (ESA)-National Government Services, Inc. 10/01/2015
L33618 Major Joint Replacement (Hip and Knee)-First Coast Service Options, Inc. 10/01/2015
L33619 Nonvascular Extremity Ultrasound-National Government Services, Inc. 10/01/2015
L33621 Ophthalmic Biometry for Intraocular Lens Power Calculation-National Government Services, Inc. 10/01/2015
L33622 Pain Management-National Government Services, Inc. 10/01/2015
L33623 Percutaneous Coronary Intervention-National Government Services, Inc. 10/01/2015
L33624 Psychiatric Inpatient Hospitalization-National Government Services, Inc. 10/01/2015
L33626 Psychiatric Partial Hospitalization Programs-National Government Services, Inc. 10/01/2015
L33627 Non-Invasive Vascular Studies-National Government Services, Inc. 10/01/2015
L33628 Panretinal (Scatter) Laser Photocoagulation-National Government Services, Inc. 10/01/2015
L33629 Non-covered Services-National Government Services, Inc. 10/01/2015
L33630 Corneal Pachymetry-National Government Services, Inc. 10/01/2015
L33631 Outpatient Physical and Occupational Therapy Services-National Government Services, Inc. 10/01/2015
L33632 Psychiatry and Psychology Services-National Government Services, Inc. 10/01/2015
L33633 Magnetic Resonance Angiography (MRA)-National Government Services, Inc. 10/01/2015
L33636 Routine Foot Care and Debridement of Nails-National Government Services, Inc. 10/01/2015
L33641 Orthopedic Footwear-Noridian Administrative Services 10/01/2015
L33642 Pressure Reducing Support Surfaces - Group 2-Noridian Administrative Services 10/01/2015
L33646 Botulinum Toxins-National Government Services, Inc. 10/01/2015
L33661 Flow Cytometry-First Coast Service Options, Inc. 10/01/2015
L33667 Duplex Scan Of Lower Extremity Arteries-First Coast Service Options, Inc. 10/01/2015
L33669 Electrocardiography-First Coast Service Options, Inc. 10/01/2015
L33670 Fundus Photography-First Coast Service Options, Inc. 10/01/2015
L33671 Diagnostic Colonoscopy-First Coast Service Options, Inc. 10/01/2015
L33674 Duplex Scanning-First Coast Service Options, Inc. 10/01/2015
L33684 Hemophilia Clotting Factors-First Coast Service Options, Inc. 10/01/2015
L33685 Luteinizing Hormone-Releasing Hormone (LHRH) Analogs-First Coast Service Options, Inc. 10/01/2015
L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis-Noridian Administrative Services 10/01/2015
L33689 Mohs Micrographic Surgery (MMS)-First Coast Service Options, Inc. 10/01/2015
L33690 Automatic External Defibrillators-Noridian Administrative Services 10/01/2015
L33692 Pressure Reducing Support Surfaces - Group 3-Noridian Administrative Services 10/01/2015
L33693 Non-Invasive Evaluation of Extremity Veins-First Coast Service Options, Inc. 10/01/2015
L33695 Non-invasive Extracranial Arterial Studies-First Coast Service Options, Inc. 10/01/2015
L33696 Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries-First Coast Service Options, Inc. 10/01/2015
L33704 Infliximab (Remicade TM )-First Coast Service Options, Inc. 10/01/2015
L33705 Ocular Photodynamic Therapy (OPT) with Verteporfin-First Coast Service Options, Inc. 10/01/2015
L33707 Pulmonary Diagnostic Services-First Coast Service Options, Inc. 10/01/2015
L33708 Plerixafor (Mozobil ®)-First Coast Service Options, Inc. 10/01/2015
L33715 Renal Angiography-First Coast Service Options, Inc. 10/01/2015
L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea-Noridian Administrative Services 10/01/2015
L33721 Computed Tomography Scans of the Head or Brain-First Coast Service Options, Inc. 10/01/2015
L33722 Doxorubicin, Liposomal (Doxil/Lipodox)-First Coast Service Options, Inc. 10/01/2015
L33723 Etoposide (Etopophos®, Toposar®, Vepesid®, VP-16)-First Coast Service Options, Inc. 10/01/2015
L33726 Gemcitabine (Gemzar)-First Coast Service Options, Inc. 10/01/2015
L33727 Irinotecan-First Coast Service Options, Inc. 10/01/2015
L33729 Oxaliplatin (Eloxatin®)-First Coast Service Options, Inc. 10/01/2015
L33730 Paclitaxel (Taxol®)-First Coast Service Options, Inc. 10/01/2015
L33733 Canes and Crutches-Noridian Administrative Services 10/01/2015
L33735 Cold Therapy-Noridian Administrative Services 10/01/2015
L33736 Commodes-Noridian Administrative Services 10/01/2015
L33737 Eye Prostheses-Noridian Administrative Services 10/01/2015
L33738 Facial Prostheses-Noridian Administrative Services 10/01/2015
L33739 Speech Generating Devices (SGD)-Noridian Administrative Services 10/01/2015
L33745 Respiratory Therapeutic Services-First Coast Service Options, Inc. 10/01/2015
L33746 Rituximab (Rituxan®)-First Coast Service Options, Inc. 10/01/2015
L33747 Pegfilgrastim (Neulasta®)-First Coast Service Options, Inc. 10/01/2015
L33748 Romiplostim (Nplate®)-First Coast Service Options, Inc. 10/01/2015
L33751 Scanning Computerized Ophthalmic Diagnostic Imaging-First Coast Service Options, Inc. 10/01/2015
L33752 Topotecan Hydrochloride (Hycamtin®)-First Coast Service Options, Inc. 10/01/2015
L33754 Syphilis Test-First Coast Service Options, Inc. 10/01/2015
L33755 Susceptibility Studies-First Coast Service Options, Inc. 10/01/2015
L33756 Transesophageal Echocardiogram-First Coast Service Options, Inc. 10/01/2015
L33762 Treatment of varicose veins of the lower extremity-First Coast Service Options, Inc. 10/01/2015
L33763 Vascular Stenting of Lower Extremity Arteries-First Coast Service Options, Inc. 10/01/2015
L33765 Blepharoplasty, Eyelid Surgery, and Brow Lift-Palmetto GBA 10/01/2015
L33766 Visual Field Examination-First Coast Service Options, Inc. 10/01/2015
L33767 Viscosupplementation Therapy For Knee-First Coast Service Options, Inc. 10/01/2015
L33768 Transthoracic Echocardiography (TTE)-First Coast Service Options, Inc. 10/01/2015
L33771 Vitamin D; 25 hydroxy, includes fraction(s), if performed-First Coast Service Options, Inc. 10/01/2015
L33774 Wireless Capsule Endoscopy-First Coast Service Options, Inc. 10/01/2015
L33777 Noncovered Services-First Coast Service Options, Inc. 10/01/2015
L33783 Enteral Nutrition-Noridian Administrative Services 10/01/2015
L33784 Heating Pads and Heat Lamps-Noridian Administrative Services 10/01/2015
L33785 High Frequency Chest Wall Oscillation Devices-Noridian Administrative Services 10/01/2015
L33786 Intrapulmonary Percussive Ventilation System-Noridian Administrative Services 10/01/2015
L33787 Lower Limb Prostheses-Noridian Administrative Services 10/01/2015
L33788 Manual Wheelchair Bases-Noridian Administrative Services 10/01/2015
L33789 Power Mobility Devices-Noridian Administrative Services 10/01/2015
L33790 Spinal Orthoses: TLSO and LSO-Noridian Administrative Services 10/01/2015
L33791 Walkers-Noridian Administrative Services 10/01/2015
L33792 Wheelchair Options/Accessories-Noridian Administrative Services 10/01/2015
L33793 Refractive Lenses-Noridian Administrative Services 10/01/2015
L33794 External Infusion Pumps-Noridian Administrative Services 10/01/2015
L33795 Mechanical In-exsufflation Devices-Noridian Administrative Services 10/01/2015
L33796 Osteogenesis Stimulators-Noridian Administrative Services 10/01/2015
L33797 Oxygen and Oxygen Equipment-Noridian Administrative Services 10/01/2015
L33798 Parenteral Nutrition-Noridian Administrative Services 10/01/2015
L33799 Patient Lifts-Noridian Administrative Services 10/01/2015
L33800 Respiratory Assist Devices-Noridian Administrative Services 10/01/2015
L33801 Seat Lift Mechanisms-Noridian Administrative Services 10/01/2015
L33802 Transcutaneous Electrical Nerve Stimulators (TENS)-Noridian Administrative Services 10/01/2015
L33803 Urological Supplies-Noridian Administrative Services 10/01/2015
L33804 Allergen Immunotherapy-First Coast Service Options, Inc. 10/01/2015
L33807 Caspofungin acetate (Cancidas(R))-First Coast Service Options, Inc. 10/01/2015
L33808 Cataract Extraction-First Coast Service Options, Inc. 10/01/2015
L33809 Chelation Therapy-First Coast Service Options, Inc. 10/01/2015
L33810 Computerized Corneal Topography-First Coast Service Options, Inc. 10/01/2015
L33811 Corticotropin-First Coast Service Options, Inc. 10/01/2015
L33812 Destruction by neurolytic agent; interdigital nerve of the foot—Morton’s Neuroma-First Coast Service Options, Inc. 10/01/2015
L33813 Destruction of Malignant Skin Lesions-First Coast Service Options, Inc. 10/01/2015
L33814 Destruction of Paravertebral Facet Joint Nerve(s)-First Coast Service Options, Inc. 10/01/2015
L33815 Diagnostic Nasal Endoscopy-First Coast Service Options, Inc. 10/01/2015
L33816 Duplex scan for erectile dysfunction-First Coast Service Options, Inc. 10/01/2015
L33817 E&M Home and Domiciliary Visits-First Coast Service Options, Inc. 10/01/2015
L33818 Excision of Malignant Skin Lesions-First Coast Service Options, Inc. 10/01/2015
L33819 External Ocular Photography-First Coast Service Options, Inc. 10/01/2015
L33820 Hospital Beds And Accessories-Noridian Administrative Services 10/01/2015
L33821 Negative Pressure Wound Therapy Pumps-Noridian Administrative Services 10/01/2015
L33822 Glucose Monitors-Noridian Administrative Services 10/01/2015
L33823 Cervical Traction Devices-Noridian Administrative Services 10/01/2015
L33824 Immunosuppressive Drugs-Noridian Administrative Services 10/01/2015
L33825 Infrared Heating Pad Systems-Noridian Administrative Services 10/01/2015
L33826 Oral Anticancer Drugs-Noridian Administrative Services 10/01/2015
L33827 Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)-Noridian Administrative Services 10/01/2015
L33828 Ostomy Supplies-Noridian Administrative Services 10/01/2015
L33829 Pneumatic Compression Devices-Noridian Administrative Services 10/01/2015
L33830 Pressure Reducing Support Surfaces - Group 1-Noridian Administrative Services 10/01/2015
L33831 Surgical Dressings-Noridian Administrative Services 10/01/2015
L33832 Tracheostomy Care Supplies-Noridian Administrative Services 10/01/2015
L33833 Surgical Treatment of Nails-First Coast Service Options, Inc. 10/01/2015
L33834 Health and Behavior Assessment/Intervention-First Coast Service Options, Inc. 10/01/2015
L33902 Comprehensive Motion Analysis Studies-First Coast Service Options, Inc. 10/01/2015
L33903 Diagnostic Laryngoscopy-First Coast Service Options, Inc. 10/01/2015
L33904 B-Scan-First Coast Service Options, Inc. 10/01/2015
L33906 Epidural-First Coast Service Options, Inc. 10/01/2015
L33907 Hepatic (Liver) Function Panel-First Coast Service Options, Inc. 10/01/2015
L33908 High Sensitivity C-Reactive Protein (hsCRP)-First Coast Service Options, Inc. 10/01/2015
L33909 Incision and Drainage of Abscess of Skin, Subcutaneous and Accessory Structures-First Coast Service Options, Inc. 10/01/2015
L33910 Independent Diagnostic Testing Facility (IDTF)-First Coast Service Options, Inc. 10/01/2015
L33911 Indocyanine-Green Angiography-First Coast Service Options, Inc. 10/01/2015
L33912 Injection of Trigger Points-First Coast Service Options, Inc. 10/01/2015
L33913 Interferon-First Coast Service Options, Inc. 10/01/2015
L33914 Iridotomy by Laser Surgery-First Coast Service Options, Inc. 10/01/2015
L33915 Label and Off-label Coverage of Outpatient Drugs and Biologicals-First Coast Service Options, Inc. 10/01/2015
L33917 Laser Trabeculoplasty-First Coast Service Options, Inc. 10/01/2015
L33918 Laser Treatment for Psoriasis-First Coast Service Options, Inc. 10/01/2015
L33919 Macugen (pegaptanib sodium injection)-First Coast Service Options, Inc. 10/01/2015
L33920 Mastoidectomy Cavity Debridement-First Coast Service Options, Inc. 10/01/2015
L33922 Nail Debridement-First Coast Service Options, Inc. 10/01/2015
L33923 Noninvasive Ear or Pulse Oximetry For Oxygen Saturation-First Coast Service Options, Inc. 10/01/2015
L33924 Omalizumab (Xolair®)-First Coast Service Options, Inc. 10/01/2015
L33925 Ophthalmological Diagnostic Services-First Coast Service Options, Inc. 10/01/2015
L33926 Oprelvekin (Neumega®)-First Coast Service Options, Inc. 10/01/2015
L33927 Optical Coherence Biometry-First Coast Service Options, Inc. 10/01/2015
L33928 Osteogenic Stimulation-First Coast Service Options, Inc. 10/01/2015
L33929 Osteopathic Manipulative Treatment-First Coast Service Options, Inc. 10/01/2015
L33930 Paravertebral Facet Joint Blocks-First Coast Service Options, Inc. 10/01/2015
L33933 Peripheral Nerve Blocks-First Coast Service Options, Inc. 10/01/2015
L33934 Physician Certification and Recertification of Home Health Services-First Coast Service Options, Inc. 10/01/2015
L33935 Post-Voiding Residual Ultrasound-First Coast Service Options, Inc. 10/01/2015
L33937 Proton Beam Radiotherapy-First Coast Service Options, Inc. 10/01/2015
L33939 Reduction Mammaplasty-First Coast Service Options, Inc. 10/01/2015
L33941 Routine Foot Care-First Coast Service Options, Inc. 10/01/2015
L33942 Physical Therapy - Home Health-CGS Administrators, LLC 10/01/2015
L33943 B-type Natriuretic Peptide (BNP) Testing-CGS Administrators, LLC 10/01/2015
L33944 Blepharoplasty-CGS Administrators, LLC 10/01/2015
L33945 Cerumen (Earwax) Removal-CGS Administrators, LLC 10/01/2015
L33946 Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy-CGS Administrators, LLC 10/01/2015
L33947 Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)-CGS Administrators, LLC 10/01/2015
L33949 Botulinum Toxins-CGS Administrators, LLC 10/01/2015
L33950 Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography-CGS Administrators, LLC 10/01/2015
L33951 Circulating Tumor Cell Marker Assays-CGS Administrators, LLC 10/01/2015
L33952 Cardiac Event Detection-CGS Administrators, LLC 10/01/2015
L33954 Cataract Extraction-CGS Administrators, LLC 10/01/2015
L33957 Sacroiliac Joint Injection-First Coast Service Options, Inc. 10/01/2015
L33958 Somatosensory Testing-First Coast Service Options, Inc. 10/01/2015
L33959 Cardiac Catheterization and Coronary Angiography-CGS Administrators, LLC 10/01/2015
L33960 Cardiovascular Nuclear Medicine-CGS Administrators, LLC 10/01/2015
L33961 Therapy Services billed by Physicians/Nonphysician Practitioners -First Coast Service Options, Inc. 10/01/2015
L33963 Tympanometry-First Coast Service Options, Inc. 10/01/2015
L33965 Urinary Tumor Markers for Bladder Cancer-First Coast Service Options, Inc. 10/01/2015
L33966 Vestibular Function Tests-First Coast Service Options, Inc. 10/01/2015
L33967 Vitamin B 12 Injections-First Coast Service Options, Inc. 10/01/2015
L33968 Yag Laser Capsulotomy-First Coast Service Options, Inc. 10/01/2015
L33969 Diagnostic Aerosol or Vapor Inhalation-First Coast Service Options, Inc. 10/01/2015
L33970 Frequency of Hemodialysis Services-First Coast Service Options, Inc. 10/01/2015
L33972 Psychiatric Partial Hospitalization Program-First Coast Service Options, Inc. 10/01/2015
L33974 Troponin-First Coast Service Options, Inc. 10/01/2015
L33975 Psychiatric Inpatient Hospitalization-First Coast Service Options, Inc. 10/01/2015
L33977 Transcranial Doppler Studies-First Coast Service Options, Inc. 10/01/2015
L33978 Pemetrexed-First Coast Service Options, Inc. 10/01/2015
L33979 Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)-Noridian Healthcare Solutions, LLC 10/01/2015
L33982 Chiropractic Services-CGS Administrators, LLC 10/01/2015
L33985 Transplantation Immune Cell Function Assay (ImmuKnow®)-First Coast Service Options, Inc. 10/01/2015
L33987 Computerized Dynamic Posturography-First Coast Service Options, Inc. 10/01/2015
L33989 Docetaxel (Taxotere®)-First Coast Service Options, Inc. 10/01/2015
L33990 Doxorubicin HCl-First Coast Service Options, Inc. 10/01/2015
L33991 Endoscopic and Percutaneous Lysis of Epidural Adhesions-First Coast Service Options, Inc. 10/01/2015
L33996 Vitamin D Assay Testing-CGS Administrators, LLC 10/01/2015
L33997 Fluorescein Angiography-First Coast Service Options, Inc. 10/01/2015
L33998 Fulvestrant (Faslodex®)-First Coast Service Options, Inc. 10/01/2015
L33999 Corneal Pachymetry-CGS Administrators, LLC 10/01/2015
L34000 Ganciclovir and Cidofovir-First Coast Service Options, Inc. 10/01/2015
L34001 Vinorelbine Tartrate (Navelbine®)-First Coast Service Options, Inc. 10/01/2015
L34002 G-CSF ( Neupogen®, Granix™,Zarxio™ )-First Coast Service Options, Inc. 10/01/2015
L34003 Hepatitis B Surface Antibody and Surface Antigen-First Coast Service Options, Inc. 10/01/2015
L34005 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-CGS Administrators, LLC 10/01/2015
L34006 Interspinous Process Decompression-First Coast Service Options, Inc. 10/01/2015
L34007 Intravenous Immune Globulin-First Coast Service Options, Inc. 10/01/2015
L34008 Computerized Corneal Topography-CGS Administrators, LLC 10/01/2015
L34009 Chiropractic Services-Noridian Healthcare Solutions, LLC 10/01/2015
L34010 Treatment of Varicose Veins of the Lower Extremities-Noridian Healthcare Solutions, LLC 10/01/2015
L34011 Ionized Calcium-First Coast Service Options, Inc. 10/01/2015
L34012 Leucovorin (Wellcovorin®)-First Coast Service Options, Inc. 10/01/2015
L34013 Lung Volume Reduction Surgery-First Coast Service Options, Inc. 10/01/2015
L34014 Magnesium-First Coast Service Options, Inc. 10/01/2015
L34015 Mitomycin (Mutamycin®, Mitomycin-C)-First Coast Service Options, Inc. 10/01/2015
L34017 Ophthalmoscopy-First Coast Service Options, Inc. 10/01/2015
L34018 Parathormone (Parathyroid Hormone)-First Coast Service Options, Inc. 10/01/2015
L34019 Rho (D) Immune Globulin Intravenous-First Coast Service Options, Inc. 10/01/2015
L34020 Sargramostim (GM-CSF, Leukine ®)-First Coast Service Options, Inc. 10/01/2015
L34021 Sedimentation Rate, Erythrocyte-First Coast Service Options, Inc. 10/01/2015
L34022 Serum Phosphorus-First Coast Service Options, Inc. 10/01/2015
L34023 Strapping-First Coast Service Options, Inc. 10/01/2015
L34025 Surgical Decompression for Peripheral Polyneuropathy-First Coast Service Options, Inc. 10/01/2015
L34026 Trastuzumab (Herceptin®)-First Coast Service Options, Inc. 10/01/2015
L34027 Ultrasound, Soft Tissues of Head and Neck-First Coast Service Options, Inc. 10/01/2015
L34028 Upper Eyelid and Brow Surgical Procedures-First Coast Service Options, Inc. 10/01/2015
L34029 Urinalysis-First Coast Service Options, Inc. 10/01/2015
L34031 Total Calcium-First Coast Service Options, Inc. 10/01/2015
L34032 Debridement Services-CGS Administrators, LLC 10/01/2015
L34037 Flow Cytometry-CGS Administrators, LLC 10/01/2015
L34038 B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L34040 Polysomnography and Other Sleep Studies-Noridian Healthcare Solutions, LLC 10/01/2015
L34042 Creatine Kinase (CK), (CPK)-First Coast Service Options, Inc. 10/01/2015
L34043 Dysphagia/Swallowing Diagnosis and Therapy-First Coast Service Options, Inc. 10/01/2015
L34045 Non-Invasive Vascular Studies-CGS Administrators, LLC 10/01/2015
L34046 Speech-Language Pathology-CGS Administrators, LLC 10/01/2015
L34048 Vertebroplasty and Vertebral Augmentation (Percutaneous)-CGS Administrators, LLC 10/01/2015
L34049 Outpatient Physical and Occupational Therapy Services-CGS Administrators, LLC 10/01/2015
L34051 Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L34052 Chest X-Ray Policy-Noridian Healthcare Solutions, LLC 10/01/2015
L34053 Application of Cellular and/or Tissue Based Products (CTPs) for Wounds of Lower Extremities-CGS Administrators, LLC 10/01/2015
L34054 B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L34055 Virtual Colonoscopy (CT Colonography)-CGS Administrators, LLC 10/01/2015
L34056 Urodynamics-CGS Administrators, LLC 10/01/2015
L34057 B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L34059 Serum Magnesium-Noridian Healthcare Solutions, LLC 10/01/2015
L34061 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-CGS Administrators, LLC 10/01/2015
L34062 Dialysis Access Maintenance-CGS Administrators, LLC 10/01/2015
L34063 RAST Type Tests-CGS Administrators, LLC 10/01/2015
L34064 Panretinal (Scatter) Laser Photocoagulation-CGS Administrators, LLC 10/01/2015
L34066 Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC 10/01/2015
L34072 Sensory Evoked Potentials & Intraoperative Neurophysiology Monitoring-Noridian Healthcare Solutions, LLC 10/01/2015
L34074 Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC 10/01/2015
L34076 Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC 10/01/2015
L34080 Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC 10/01/2015
L34081 Endoscopy by Capsule-CGS Administrators, LLC 10/01/2015
L34082 Varicose Veins of the Lower Extremity, Treatment of-CGS Administrators, LLC 10/01/2015
L34084 Transcatheter Infusion Therapy-CGS Administrators, LLC 10/01/2015
L34085 Post-Void Residual Urine and/or Bladder Capacity by Ultrasound-CGS Administrators, LLC 10/01/2015
L34086 Polysomnography and Sleep Studies-CGS Administrators, LLC 10/01/2015
L34087 Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based-CGS Administrators, LLC 10/01/2015
L34089 Human Papillomavirus (HPV) Testing-CGS Administrators, LLC 10/01/2015
L34090 Laser Ablation of the Prostate-CGS Administrators, LLC 10/01/2015
L34092 Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC 10/01/2015
L34093 Chemotherapy and Biologicals-CGS Administrators, LLC 10/01/2015
L34094 Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L34097 Chest X-Ray Policy-Noridian Healthcare Solutions, LLC 10/01/2015
L34100 Monitored Anesthesia Care (MAC)-Noridian Healthcare Solutions, LLC 10/01/2015
L34106 Percutaneous Vertebral Augmentation-Noridian Healthcare Solutions, LLC 10/01/2015
L34107 Erythropoiesis Stimulating Agents (ESAs)-Noridian Healthcare Solutions, LLC 10/01/2015
L34133 Cranial Computerized Tomography (CCT) Scans-Noridian Healthcare Solutions, LLC 10/01/2015
L34136 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-Noridian Healthcare Solutions, LLC 10/01/2015
L34149 Respiratory Care (Respiratory Therapy )-Noridian Healthcare Solutions, LLC 10/01/2015
L34151 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-Noridian Healthcare Solutions, LLC 10/01/2015
L34160 Surgical Decompression for Peripheral Polyneuropathy-Noridian Healthcare Solutions, LLC 10/01/2015
L34161 Total Joint Arthroplasty-Noridian Healthcare Solutions, LLC 10/01/2015
L34163 Total Hip Arthroplasty-Noridian Healthcare Solutions, LLC 10/01/2015
L34165 Erythropoietin Stimulating Agents (ESA)-Noridian Healthcare Solutions, LLC 10/01/2015
L34167 Erythropoietin Stimulating Agents (ESA)-Noridian Healthcare Solutions, LLC 10/01/2015
L34168 Percutaneous Vertebral Augmentation-Noridian Healthcare Solutions, LLC 10/01/2015
L34171 Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation-CGS Administrators, LLC 10/01/2015
L34175 Ophthalmic Angiography (Fluorescein and Indocyanine Green)-CGS Administrators, LLC 10/01/2015
L34176 Polysomnography and Sleep Studies-Noridian Healthcare Solutions, LLC 10/01/2015
L34181 Ophthalmic Biometry for Intraocular Lens Power Calculation-CGS Administrators, LLC 10/01/2015
L34182 Treatment of Varicose Veins of the Lower Extremities-Noridian Healthcare Solutions, LLC 10/01/2015
L34183 Psychiatric Inpatient Hospitalization-CGS Administrators, LLC 10/01/2015
L34184 Percutaneous Vertebral Augmentation-Noridian Healthcare Solutions, LLC 10/01/2015
L34194 Blepharoplasty, Eyelid Surgery, and Brow Lift-Noridian Healthcare Solutions, LLC 10/01/2015
L34195 Mohs Micrographic Surgery-CGS Administrators, LLC 10/01/2015
L34196 Psychiatric Partial Hospitalization Programs-CGS Administrators, LLC 10/01/2015
L34199 Treatment of Ulcers & Symptomatic Hyperkeratoses-Noridian Healthcare Solutions, LLC 10/01/2015
L34200 Removal of Benign Skin Lesions-CGS Administrators, LLC 10/01/2015
L34202 Erythropoiesis Stimulating Agents (ESAs)-Noridian Healthcare Solutions, LLC 10/01/2015
L34203 Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC 10/01/2015
L34207 Wireless Gastrointestinal Motility Monitoring Systems-Noridian Healthcare Solutions, LLC 10/01/2015
L34209 Treatment of Varicose Veins of the Lower Extremities-Noridian Healthcare Solutions, LLC 10/01/2015
L34211 Trigger Point Injections-Noridian Healthcare Solutions, LLC 10/01/2015
L34213 Diagnostic and Therapeutic Colonoscopy -Noridian Healthcare Solutions, LLC 10/01/2015
L34215 Flow Cytometry-Noridian Healthcare Solutions, LLC 10/01/2015
L34216 Polysomnography and Sleep Studies for Testing Sleep and Respiratory Disorders-Noridian Healthcare Solutions, LLC 10/01/2015
L34217 Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC 10/01/2015
L34218 Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC 10/01/2015
L34219 Noninvasive Peripheral Arterial Studies-Noridian Healthcare Solutions, LLC 10/01/2015
L34220 Lumbar MRI-Noridian Healthcare Solutions, LLC 10/01/2015
L34221 Noninvasive Cerebrovascular Studies-Noridian Healthcare Solutions, LLC 10/01/2015
L34223 Stereotactic Radiosurgery-Noridian Healthcare Solutions, LLC 10/01/2015
L34224 Stereotactic Body Radiation Therapy-Noridian Healthcare Solutions, LLC 10/01/2015
L34226 Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Noridian Healthcare Solutions, LLC 10/01/2015
L34228 Percutaneous Vertebral Augmentation-Noridian Healthcare Solutions, LLC 10/01/2015
L34229 Noninvasive Peripheral Venous Studies-Noridian Healthcare Solutions, LLC 10/01/2015
L34233 Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)-Noridian Healthcare Solutions, LLC 10/01/2015
L34242 Chiropractic Services-Noridian Healthcare Solutions, LLC 10/01/2015
L34243 Treatment of Ulcers & Symptomatic Hyperkeratoses-Noridian Healthcare Solutions, LLC 10/01/2015
L34246 Routine Foot Care and Debridement of Nails-CGS Administrators, LLC 10/01/2015
L34247 Pulmonary Function Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L34251 Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC 10/01/2015
L34252 Drugs and Biologicals: Antiangiogenic Therapy for Ophthalmic Conditions-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34253 Drugs and Biologicals: Botulinum Toxins-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34254 Drugs and Biologicals: Colony Stimulating Factors-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34255 Drugs and Biologicals: Erythropoietin Analogues-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34256 Drugs and Biologicals: Immune Globulin Intravenous (IVIg)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34257 Drugs and Biologicals: Infliximab (REMICADE ®)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34258 Drugs and Biologicals: Octreotide Acetate for Injectable Suspension (Sandostatin LAR ® Depot)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34259 Drugs and Biologicals: Palonosetron HCL Injection (Aloxi)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34260 Drugs and Biologicals: Zoledronic Acid-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34261 Medicine: Chiropractic Services-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34262 Medicine: Health and Behavior Assessment/Intervention-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34263 Medicine: Hydration Therapy-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34264 Medicine: Long-Term Wearable Electrocardiographic Monitoring (WEM)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34266 Medicine: Neurophysiology Evoked Potentials (NEPs)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34267 Medicine: Noninvasive Peripheral Arterial and Venous Studies-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34268 Medicine: Noninvasive Vascular Studies of Abdominal, Pelvic, Scrotal Contents and/or Retroperitoneal Organs-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34269 Medicine: Repetitive Transcranial Magnetic Stimulation (rTMS) for Resistant Depression-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34270 Medicine: Wireless Capsule Imaging-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34271 Pathology and Laboratory: B-type Natriuretic Peptide (BNP) Testing-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34272 Pathology and Laboratory: C-Reactive Protein; High Sensitivity (hsCRP)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34273 Pathology and Laboratory: Circulating Tumor Cells (CTC) Assays-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34274 Pathology and Laboratory: Vitamin D Assay Testing-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34275 Radiology: Computed Tomographic (CT) Colonography-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34276 Radiology: Computed Tomographic Angiography of the Heart and Coronary Vessels-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34277 Radiology: Computed Tomography of the Abdomen and Pelvis-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34278 Radiology: Magnetic Resonance Imaging of the Brain-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34279 Radiology: Myocardial Perfusion Imaging (MPI)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34280 Radiology: Nonobstetric Pelvic Ultrasound-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34281 Radiology: PET for Myocardial Perfusion Imaging (MPI) and Myocardial Viability (MV)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34282 Radiology: Proton Beam Therapy-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34283 Radiology: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34284 Surgery: Arthrocentesis, Aspiration, and/or Injection; Major Joint or Bursa-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34285 Surgery: Bioengineered Skin Substitutes (BSS) for the Treatment of Diabetic and Venous Stasis Ulcers of the Lower Extremities-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34286 Surgery: Blepharoplasty-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34287 Surgery: Cataract Extraction-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34288 Surgery: Colonoscopy (Diagnostic)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34289 Surgery: Continuous Peripheral Nerve Blocks (CPNB)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34290 Surgery: Debridement Services-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34291 Surgery: Injections of the Spinal Canal-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34292 Surgery: Interventional Renal Denervation (IRD) for Resistant Hypertension-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34293 Surgery: Lumbar Facet Blockade-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34294 Surgery: Major Joint Replacement (Hip and Knee)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34295 Surgery: Nerve Blocks and Electrostimulation for Peripheral Neuropathy-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34296 Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34297 Surgery: Removal of Benign or Premalignant Skin Lesions-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34298 Surgery: Transoral Incisionless Fundoplication (TIF)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34299 Surgery: Trigger Point Injections-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34300 Surgery: Vertebral Augmentation Procedures (VAPs)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34301 Surgery: YAG Capsulotomy-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34302 Transportation Services: Ambulance-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34303 Drugs and Biologicals: Bevacizumab (AVASTIN®)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34304 Drugs and Biologicals: Gemcitabine Hydrochloride (Gemzar ®)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34305 Drugs and Biologicals: Oxaliplatin (Eloxatin ®)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34306 Drugs and Biologicals: Rituximab (Rituxan ®)-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34307 Medicine: Dysphagia/Swallowing Therapy-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34308 Medicine: Occupational Therapy - Outpatient-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34309 Medicine: Partial Hospitalization Programs-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34310 Medicine: Physical Therapy - Outpatient-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34311 Medicine: Speech Language Pathology - Outpatient-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34313 Allergy Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L34314 Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC 10/01/2015
L34315 Electrocardiograms-Noridian Healthcare Solutions, LLC 10/01/2015
L34317 Radiologic Examination, Chest-Noridian Healthcare Solutions, LLC 10/01/2015
L34324 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC 10/01/2015
L34328 Peripheral Nerve and Peripheral Nerve Field Stimulation-Noridian Healthcare Solutions, LLC 10/01/2015
L34337 Transesophageal Echocardiography (TEE)-CGS Administrators, LLC 10/01/2015
L34338 Transthoracic Echocardiography (TTE)-CGS Administrators, LLC 10/01/2015
L34353 Outpatient Psychiatry and Psychology Services-CGS Administrators, LLC 10/01/2015
L34356 Erythropoiesis Stimulating Agents (ESA)-CGS Administrators, LLC 10/01/2015
L34370 Category III CPT® Codes-CGS Administrators, LLC 10/01/2015
L34372 Magnetic Resonance Angiography (MRA)-First Coast Service Options, Inc. 10/01/2015
L34373 Magnetic Resonance Imaging (MRI) of Any Joint of the Lower Extremities-First Coast Service Options, Inc. 10/01/2015
L34374 Magnetic Resonance Imaging of the Brain-First Coast Service Options, Inc. 10/01/2015
L34375 Magnetic Resonance Imaging of the Orbit, Face, and/or Neck-First Coast Service Options, Inc. 10/01/2015
L34376 Magnetic Resonance Imaging of the Spine-First Coast Service Options, Inc. 10/01/2015
L34377 Magnetic Resonance Imaging of Upper Extremity-First Coast Service Options, Inc. 10/01/2015
L34380 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-National Government Services, Inc. 10/01/2015
L34393 Ocular Photography - External-CGS Administrators, LLC 10/01/2015
L34394 Visual Fields Testing-CGS Administrators, LLC 10/01/2015
L34399 Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)-CGS Administrators, LLC 10/01/2015
L34410 B-type Natriuretic Peptide (BNP) Testing-Palmetto GBA 10/01/2015
L34411 Blepharoplasty, Eyelid Surgery, and Brow Lift-Palmetto GBA 10/01/2015
L34412 Cardiac Rehabilitation-Palmetto GBA 10/01/2015
L34413 Cataract Surgery-Palmetto GBA 10/01/2015
L34415 CT of the Abdomen and Pelvis-Palmetto GBA 10/01/2015
L34416 Computerized Axial Tomography of the Chest/Thorax-Palmetto GBA 10/01/2015
L34417 CT of the Head-Palmetto GBA 10/01/2015
L34419 Homocysteine Level, Serum-Palmetto GBA 10/01/2015
L34422 Infrared Coagulation (IRC) of Hemorrhoids-Palmetto GBA 10/01/2015
L34423 Ionized Calcium-Palmetto GBA 10/01/2015
L34424 Magnetic Resonance Angiography-Palmetto GBA 10/01/2015
L34425 Magnetic Resonance Imaging of the Orbit, Face, and/or Neck -Palmetto GBA 10/01/2015
L34426 Ophthalmic Angiography (Fluorescein and Indocyanine Green)-Palmetto GBA 10/01/2015
L34427 Outpatient Occupational Therapy-Palmetto GBA 10/01/2015
L34428 Outpatient Physical Therapy-Palmetto GBA 10/01/2015
L34429 Outpatient Speech Language Pathology-Palmetto GBA 10/01/2015
L34430 Respiratory Therapy (Respiratory Care)-Palmetto GBA 10/01/2015
L34431 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-Palmetto GBA 10/01/2015
L34433 Somatosensory Testing-Palmetto GBA 10/01/2015
L34434 Upper Gastrointestinal Endoscopy and Visualization-Palmetto GBA 10/01/2015
L34436 Posterior Tibial Nerve Stimulation (PTNS)-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34454 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-Palmetto GBA 10/01/2015
L34500 Medicine: Autonomic Function Tests-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34501 Pathology and Laboratory: Qualitative Drug Testing-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34512 Corneal Pachymetry-Palmetto GBA 10/01/2015
L34513 Flow Cytometry-Palmetto GBA 10/01/2015
L34518 Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing-First Coast Service Options, Inc. 10/01/2015
L34519 Molecular Pathology Procedures-First Coast Service Options, Inc. 10/01/2015
L34520 Psychological and Neuropsychological Tests-First Coast Service Options, Inc. 10/01/2015
L34521 Special EEG Tests-First Coast Service Options, Inc. 10/01/2015
L34522 Transcranial Magnetic Stimulation for Major Depressive Disorder-First Coast Service Options, Inc. 10/01/2015
L34525 Intra-articular Injections of Hyaluronan-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34526 Surgical Treatment of Obstructive Sleep Apnea (OSA)-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34528 Blepharoplasty, Blepharoptosis and Brow Lift-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34535 Polysomnography and Other Sleep Studies-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34536 Treatment of Varicose Veins of the Lower Extremities-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34537 Vestibular Function Testing-Palmetto GBA 10/01/2015
L34538 Hospice Determining Terminal Status-CGS Administrators, LLC 10/01/2015
L34539 Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians-CGS Administrators, LLC 10/01/2015
L34540 Stretta Procedure-CGS Administrators, LLC 10/01/2015
L34541 Transtelephonic Spirometry-CGS Administrators, LLC 10/01/2015
L34544 Hospice - Liver Disease-Palmetto GBA 10/01/2015
L34545 Intravenous Immunoglobulin (IVIG)-Palmetto GBA 10/01/2015
L34546 Home-Based Fall Evaluations and Interventions-Palmetto GBA 10/01/2015
L34547 Hospice - Neurological Conditions-Palmetto GBA 10/01/2015
L34548 Hospice Cardiopulmonary Conditions-Palmetto GBA 10/01/2015
L34549 Ambulance Services-Palmetto GBA 10/01/2015
L34551 One Day Stays for Chest Pain-Palmetto GBA 10/01/2015
L34552 Outpatient Observation Bed/Room Services-Palmetto GBA 10/01/2015
L34553 Stretta Procedure-Palmetto GBA 10/01/2015
L34554 In Vitro Chemosensitivity & Chemoresistance Assays-Palmetto GBA 10/01/2015
L34555 Non-Covered Category III CPT Codes-Palmetto GBA 10/01/2015
L34556 Spinal Cord Stimulators for Chronic Pain-Palmetto GBA 10/01/2015
L34558 Hospice The Adult Failure To Thrive Syndrome-Palmetto GBA 10/01/2015
L34559 Hospice - Renal Care-Palmetto GBA 10/01/2015
L34560 Home Health Occupational Therapy-Palmetto GBA 10/01/2015
L34561 Home Health - Psychiatric Care-Palmetto GBA 10/01/2015
L34562 Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's Disease and Behavioral Disturbances-Palmetto GBA 10/01/2015
L34563 Home Health Speech-Language Pathology-Palmetto GBA 10/01/2015
L34564 Home Health Physical Therapy-Palmetto GBA 10/01/2015
L34565 Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia-Palmetto GBA 10/01/2015
L34566 Hospice - HIV Disease-Palmetto GBA 10/01/2015
L34567 Hospice Alzheimer's Disease & Related Disorders-Palmetto GBA 10/01/2015
L34570 Psychiatric Inpatient Hospitalization-Palmetto GBA 10/01/2015
L34573 Cardiac Event Detection-Palmetto GBA 10/01/2015
L34574 Dental Services-Palmetto GBA 10/01/2015
L34575 Frequency of Dialysis-Palmetto GBA 10/01/2015
L34576 Laparoscopic Sleeve Gastrectomy for Severe Obesity-Palmetto GBA 10/01/2015
L34577 Retroperitoneal Ultrasound-Palmetto GBA 10/01/2015
L34578 Surface Electrical Stimulation in the Treatment of Dysphagia-Palmetto GBA 10/01/2015
L34580 Intravenous Immunoglobulin (IVIG)-Palmetto GBA 10/01/2015
L34585 Chiropractic Services-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34587 Wound Care-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34588 Trigger Points, Local Injections-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34592 Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34594 Nerve Conduction Studies and Electromyography-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34596 Immunizations-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34614 Colonoscopy and Sigmoidoscopy-Diagnostic-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34615 Visual Fields-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34616 Psychiatry and Psychology Services-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34623 Intraoperative Neurophysiological Testing-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34624 Somatosensory Testing-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34633 Erythropoiesis Stimulating Agents (ESAs)-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34634 Proton Beam Therapy-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34635 Botulinum Toxin Type A & Type B-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34636 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34641 Transcranial Magnetic Stimulation (TMS)-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34645 Drug Testing-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34646 Psychological and Neuropsychological Testing-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34648 Bisphosphonate Drug Therapy-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34651 Flow Cytometry-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34658 Vitamin D Assay Testing-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34659 Endoscopic Treatment of GERD-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34698 Cosmetic and Reconstructive Surgery-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34699 Human Granulocyte/Macrophage Colony Stimulating Factors-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34741 Drugs and Biologics (Non-chemotherapy)-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34760 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34761 Percutaneous Coronary Interventions-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34762 Molecular Diagnostic Testing-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34771 Immune Globulins-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L34807 Lumbar Epidural Steroid Injections (ESI)-CGS Administrators, LLC 10/01/2015
L34821 Transcutaneous Electrical Joint Stimulation Devices (TEJSD)-Noridian Administrative Services 10/01/2015
L34822 Luteinizing Hormone-Releasing Hormone (LHRH) Analogs-Novitas Solutions, Inc. 10/01/2015
L34823 Tumor Treatment Field Therapy (TTFT)-Noridian Administrative Services 10/01/2015
L34824 Vacuum Erection Devices (VED)-Noridian Administrative Services 10/01/2015
L34832 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-CGS Administrators, LLC 10/01/2015
L34833 Cardiac Rhythm Device Evaluation-Novitas Solutions, Inc. 10/01/2015
L34834 Blood Glucose Monitoring in a Skilled Nursing Facility (SNF)-Novitas Solutions, Inc. 10/01/2015
L34856 C-Reactive Protein High Sensitivity Testing (hsCRP)-Novitas Solutions, Inc. 10/01/2015
L34857 Flow Cytometry-Novitas Solutions, Inc. 10/01/2015
L34859 Nerve Conduction Studies and Electromyography-First Coast Service Options, Inc. 10/01/2015
L34861 Infrared Photocoagulation (IRC) of Hemorrhoids-Novitas Solutions, Inc. 10/01/2015
L34862 Co-Management of Surgical Procedures-Novitas Solutions, Inc. 10/01/2015
L34863 Coverage of Services and Procedures in Nursing Facilities-Novitas Solutions, Inc. 10/01/2015
L34864 Loss-of-Heterozygosity Based Topographic Genotyping with PathfinderTG ®-Novitas Solutions, Inc. 10/01/2015
L34865 Magnetic Resonance Angiography (MRA)-Novitas Solutions, Inc. 10/01/2015
L34869 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Palmetto GBA 10/01/2015
L34886 Non-Covered Services-Noridian Healthcare Solutions, LLC 10/01/2015
L34887 Surgical Treatment of Nails-Novitas Solutions, Inc. 10/01/2015
L34888 Vitamin D Assay Testing-Novitas Solutions, Inc. 10/01/2015
L34891 Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy-Novitas Solutions, Inc. 10/01/2015
L34892 Paravertebral Facet and Sacroiliac Joint Injections-Novitas Solutions, Inc. 10/01/2015
L34912 Genetic Testing for Lynch Syndrome-First Coast Service Options, Inc. 10/01/2015
L34914 Assays for Vitamins and Metabolic Function-Novitas Solutions, Inc. 10/01/2015
L34924 Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities-Novitas Solutions, Inc. 10/01/2015
L34938 Removal of Benign Skin Lesions-Novitas Solutions, Inc. 10/01/2015
L34943 Pathology and Laboratory: Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34944 Surgery: Routine Foot Care-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L34953 Cardiac Event Detection Monitoring-Novitas Solutions, Inc. 10/01/2015
L34960 Hydration Therapy-Novitas Solutions, Inc. 10/01/2015
L34961 Mohs Micrographic Surgery (MMS)-Novitas Solutions, Inc. 10/01/2015
L34966 Benign Skin Lesions-Novitas Solutions, Inc. 10/01/2015
L34974 Facet Joint Injections-Novitas Solutions, Inc. 10/01/2015
L34975 Neurophysiology Evoked Potentials (NEPs)-Novitas Solutions, Inc. 10/01/2015
L34976 Vertebroplasty, Vertebral Augmentation; Percutaneous-First Coast Service Options, Inc. 10/01/2015
L34977 Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters-Novitas Solutions, Inc. 10/01/2015
L34980 Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC 10/01/2015
L34981 Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC 10/01/2015
L34982 Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC 10/01/2015
L34983 Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC 10/01/2015
L34992 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC 10/01/2015
L34993 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC 10/01/2015
L34995 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC 10/01/2015
L34996 Neuromuscular Junction Testing-Novitas Solutions, Inc. 10/01/2015
L34997 Real-Time, Outpatient Cardiac Telemetry-Novitas Solutions, Inc. 10/01/2015
L34998 Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression-Novitas Solutions, Inc. 10/01/2015
L34999 Transoral Incisionless Fundoplication-Novitas Solutions, Inc. 10/01/2015
L35000 Molecular Pathology Procedures-National Government Services, Inc. 10/01/2015
L35001 Reduction Mammaplasty-National Government Services, Inc. 10/01/2015
L35003 Intraoperative Neurophysiological Testing-Novitas Solutions, Inc. 10/01/2015
L35004 Surgery: Blepharoplasty-Novitas Solutions, Inc. 10/01/2015
L35006 Controlled Substance Monitoring and Drugs of Abuse Testing-Novitas Solutions, Inc. 10/01/2015
L35007 Vestibular and Audiologic Function Studies-Novitas Solutions, Inc. 10/01/2015
L35008 Non-Covered Services-Noridian Healthcare Solutions, LLC 10/01/2015
L35009 Prostate Mapping Biopsy-Novitas Solutions, Inc. 10/01/2015
L35010 Trigger Point Injections-Novitas Solutions, Inc. 10/01/2015
L35011 Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Novitas Solutions, Inc. 10/01/2015
L35013 Debridement of Mycotic Nails-Novitas Solutions, Inc. 10/01/2015
L35014 Frequency of Dialysis-Novitas Solutions, Inc. 10/01/2015
L35015 Molecular Diagnostics: Genitourinary Infectious Disease Testing-Novitas Solutions, Inc. 10/01/2015
L35016 Transesophageal Echocardiography (TEE)-Novitas Solutions, Inc. 10/01/2015
L35021 Hyperbaric Oxygen (HBO) Therapy-Novitas Solutions, Inc. 10/01/2015
L35022 Bariatric Surgical Management of Morbid Obesity-Novitas Solutions, Inc. 10/01/2015
L35024 MolDX: Genetic Testing for Lynch Syndrome-Palmetto GBA 10/01/2015
L35025 MolDX: Molecular Diagnostic Tests (MDT)-Palmetto GBA 10/01/2015
L35026 Rituximab (Rituxan®)-Palmetto GBA 10/01/2015
L35028 Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency-National Government Services, Inc. 10/01/2015
L35029 Nerve Blocks for Peripheral Neuropathy-National Government Services, Inc. 10/01/2015
L35032 Flow Cytometry-Novitas Solutions, Inc. 10/01/2015
L35033 Pain Management-Novitas Solutions, Inc. 10/01/2015
L35035 Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography-Novitas Solutions, Inc. 10/01/2015
L35036 Therapy and Rehabilitation Services (PT, OT)-Novitas Solutions, Inc. 10/01/2015
L35038 Scanning Computerized Ophthalmic Diagnostic Imaging-Novitas Solutions, Inc. 10/01/2015
L35041 Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds-Novitas Solutions, Inc. 10/01/2015
L35045 Cardiac Computed Tomography & Angiography (CCTA)-Palmetto GBA 10/01/2015
L35047 Oral Maxillofacial Prosthesis-Novitas Solutions, Inc. 10/01/2015
L35048 Nerve Conduction Studies and Electromyography-Palmetto GBA 10/01/2015
L35049 Monitored Anesthesia Care-Novitas Solutions, Inc. 10/01/2015
L35050 Outpatient Sleep Studies-Novitas Solutions, Inc. 10/01/2015
L35053 Chemotherapy Drugs and their Adjuncts-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35062 Biomarkers Overview-Novitas Solutions, Inc. 10/01/2015
L35064 Vascular Access for Hemodialysis-Novitas Solutions, Inc. 10/01/2015
L35068 Evaluation and Management Services Provided in a Nursing Facility-Novitas Solutions, Inc. 10/01/2015
L35070 Speech - Language Pathology (SLP) Services: Communication Disorders-Novitas Solutions, Inc. 10/01/2015
L35071 Circulating Tumor Cell Marker Assays-Palmetto GBA 10/01/2015
L35072 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Palmetto GBA 10/01/2015
L35073 MolDX: NRAS Genetic Testing-Palmetto GBA 10/01/2015
L35074 Heavy Metal Testing-National Government Services, Inc. 10/01/2015
L35075 Proton Beam Therapy-National Government Services, Inc. 10/01/2015
L35076 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-National Government Services, Inc. 10/01/2015
L35080 Endoscopic Treatment of GERD-National Government Services, Inc. 10/01/2015
L35081 Nerve Conduction Studies and Electromyography-Novitas Solutions, Inc. 10/01/2015
L35083 Cardiovascular Nuclear Medicine-Novitas Solutions, Inc. 10/01/2015
L35084 Non-Coronary Vascular Stents-Novitas Solutions, Inc. 10/01/2015
L35087 Glaucoma Treatment with Aqueous Drainage Device-Novitas Solutions, Inc. 10/01/2015
L35089 Wireless Capsule Endoscopy-Novitas Solutions, Inc. 10/01/2015
L35090 Cosmetic and Reconstructive Surgery-Novitas Solutions, Inc. 10/01/2015
L35091 Cataract Extraction (including Complex Cataract Surgery)-Novitas Solutions, Inc. 10/01/2015
L35092 Diagnostic Abdominal Aortography and Renal Angiography-Novitas Solutions, Inc. 10/01/2015
L35093 Intravenous Immune Globulin (IVIG)-Novitas Solutions, Inc. 10/01/2015
L35094 Services That Are Not Reasonable and Necessary-Novitas Solutions, Inc. 10/01/2015
L35095 Lacrimal Punctum Plugs-Novitas Solutions, Inc. 10/01/2015
L35096 Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC 10/01/2015
L35098 Nerve Conduction Studies and Electromyography-National Government Services, Inc. 10/01/2015
L35099 Frequency of Laboratory Tests-Novitas Solutions, Inc. 10/01/2015
L35101 Psychiatric Codes-Novitas Solutions, Inc. 10/01/2015
L35107 Pain Management of Peripheral Nerves by Injection-Novitas Solutions, Inc. 10/01/2015
L35111 Hemophilia Factor Products-Novitas Solutions, Inc. 10/01/2015
L35112 Implantable Infusion Pump-Novitas Solutions, Inc. 10/01/2015
L35121 Coronary Computed Tomography Angiography (CCTA)-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35124 Autonomic Function Testing-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35125 Wound Care-Novitas Solutions, Inc. 10/01/2015
L35130 Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous-Novitas Solutions, Inc. 10/01/2015
L35132 Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus-Palmetto GBA 10/01/2015
L35133 Stereotactic Computer Assisted Volumetric &/or Navigational Procedure-Noridian Healthcare Solutions, LLC 10/01/2015
L35134 Implantable Infusion Pump for Treatment of Chronic Intractable Pain-Noridian Healthcare Solutions, LLC 10/01/2015
L35136 Spinal Cord Stimulators for Chronic Pain-Noridian Healthcare Solutions, LLC 10/01/2015
L35138 Routine Foot Care-Novitas Solutions, Inc. 10/01/2015
L35139 Wound Care-Novitas Solutions, Inc. 10/01/2015
L35148 Lumbar Epidural Steroid Injections-Palmetto GBA 10/01/2015
L35160 MolDX: Molecular Diagnostic Tests (MDT)-Noridian Healthcare Solutions, LLC 10/01/2015
L35162 Ambulance Services (Ground Ambulance)-Novitas Solutions, Inc. 10/01/2015
L35163 Plastic Surgery-Noridian Healthcare Solutions, LLC 10/01/2015
L35170 Botulinum Toxin Types A and B Policy-Noridian Healthcare Solutions, LLC 10/01/2015
L35172 Botulinum Toxin Types A and B-Noridian Healthcare Solutions, LLC 10/01/2015
L35175 MRI and CT Scans of the Head, Brain, and Neck-Noridian Healthcare Solutions, LLC 10/01/2015
L35177 MRI and CT Scans of the Head, Brain, and Neck-Noridian Healthcare Solutions, LLC 10/01/2015
L35178 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC 10/01/2015
L35222 Nerve Blocks for Peripheral Neuropathy-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35249 Nerve Blocks for Peripheral Neuropathy-CGS Administrators, LLC 10/01/2015
L35332 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-CGS Administrators, LLC 10/01/2015
L35349 MolDX: Genetic Testing for Lynch Syndrome-CGS Administrators, LLC 10/01/2015
L35350 UPPER GASTROINTESTINAL ENDOSCOPY (DIAGNOSTIC AND THERAPEUTIC)-Novitas Solutions, Inc. 10/01/2015
L35360 Pulmonary Function Testing-Novitas Solutions, Inc. 10/01/2015
L35390 Magnetic Pelvic Floor Stimulation (MPFS)-Novitas Solutions, Inc. 10/01/2015
L35391 Multiple Imaging in Oncology-Novitas Solutions, Inc. 10/01/2015
L35395 Autonomic Function Tests-Novitas Solutions, Inc. 10/01/2015
L35396 Biomarkers for Oncology-Novitas Solutions, Inc. 10/01/2015
L35397 Non-Invasive Cerebrovascular Arterial Studies-Novitas Solutions, Inc. 10/01/2015
L35408 3D Interpretation and Reporting of Imaging Studies-Novitas Solutions, Inc. 10/01/2015
L35409 Non-Vascular Extremity Ultrasound-Novitas Solutions, Inc. 10/01/2015
L35424 Chiropractic Services-Novitas Solutions, Inc. 10/01/2015
L35427 Hyaluronan Acid Therapies for Osteoarthritis of the Knee-Novitas Solutions, Inc. 10/01/2015
L35428 Thrombolytic Agents-Novitas Solutions, Inc. 10/01/2015
L35433 Barium Swallow Studies, Modified-Novitas Solutions, Inc. 10/01/2015
L35434 Oximetry Services-Novitas Solutions, Inc. 10/01/2015
L35442 MolDX: NRAS Genetic Testing-CGS Administrators, LLC 10/01/2015
L35443 MolDX: GeneSight ® Assay for Refractory Depression-CGS Administrators, LLC 10/01/2015
L35447 Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC 10/01/2015
L35448 Independent Diagnostic Testing Facility (IDTF)-Novitas Solutions, Inc. 10/01/2015
L35449 Sacral Nerve Stimulation-Novitas Solutions, Inc. 10/01/2015
L35450 Spinal Cord Stimulation (Dorsal Column Stimulation)-Novitas Solutions, Inc. 10/01/2015
L35451 Non-Invasive Peripheral Venous Studies-Novitas Solutions, Inc. 10/01/2015
L35456 Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC 10/01/2015
L35457 Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC 10/01/2015
L35458 Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC 10/01/2015
L35486 Pelvic Floor Dysfunction: Anorectal Manometry and EMG-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35490 Category III Codes-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35494 Mohs Micrographic Surgery-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35498 Removal of Benign Skin Lesions-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35526 B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L35553 Pathology and Laboratory: Genetic Testing for Lynch Syndrome-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L35554 Surgery: Reduction Mammaplasty-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L35627 Non-Coverage of Extracorporeal Shock Wave Lithotripsy for Musculoskeletal Conditions-Palmetto GBA 10/01/2015
L35631 MolDX: Breast Cancer Index℠ Genetic Assay-Palmetto GBA 10/01/2015
L35632 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Palmetto GBA 10/01/2015
L35633 MolDX: GeneSight® Assay for Refractory Depression-Palmetto GBA 10/01/2015
L35658 Surgery: Implantable Hormone Pellets-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L35660 Pathology and Laboratory: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L35677 Infliximab (Remicade®)-Palmetto GBA 10/01/2015
L35679 Pharmacokinetic (PK) Testing for Chemotherapy Dosing-Novitas Solutions, Inc. 10/01/2015
L35698 CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-First Coast Service Options, Inc. 10/01/2015
L35701 Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC 10/01/2015
L35702 Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC 10/01/2015
L35703 Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC 10/01/2015
L35704 Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC 10/01/2015
L35710 Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC 10/01/2015
L35711 Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC 10/01/2015
L35724 Controlled Substance Monitoring and Drugs of Abuse Testing-Palmetto GBA 10/01/2015
L35751 Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35753 Non-Invasive Cerebrovascular Studies-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35755 Non-Invasive Abdominal / Visceral Vascular Studies-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35761 Non-Invasive Peripheral Arterial Vascular Studies-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35868 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Palmetto GBA 10/01/2015
L35869 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Palmetto GBA 10/01/2015
L35878 Infectious Disease Molecular Diagnostic Testing-CGS Administrators, LLC 10/01/2015
L35889 Surgery: Left Atrial Appendage-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L35891 Intravenous Immune Globulin-CGS Administrators, LLC 10/01/2015
L35897 Nerve Conduction Studies and Electromyography-CGS Administrators, LLC 10/01/2015
L35906 Somatosensory Testing-CGS Administrators, LLC 10/01/2015
L35920 Pathology and Laboratory: Quantitative Drug Testing-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L35922 Special Histochemical Stains and Immunohistochemical Stains-Palmetto GBA 10/01/2015
L35936 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-National Government Services, Inc. 10/01/2015
L35937 Lumbar Epidural Injections-National Government Services, Inc. 10/01/2015
L35938 Debridement of Wounds-Palmetto GBA 10/01/2015
L35941 Medicine: Psychotherapy Services-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L35942 Surgery: Fusion for Degenerative Joint Disease of the Lumbar Spine-Cahaba Government Benefit Administrators®, LLC 10/01/2015
L35974 MolDX: MGMT Promoter Methylation Analysis-Palmetto GBA 10/01/2015
L35984 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-CGS Administrators, LLC 10/01/2015
L35986 Special Histochemical Stains and Immunohistochemical Stains-CGS Administrators, LLC 10/01/2015
L35996 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L35998 Non-Coronary Vascular Stents-Wisconsin Physicians Service Insurance Corporation 10/01/2015
L36007 Lower Extremity Major Joint Replacement (Hip and Knee)-Novitas Solutions, Inc. 10/01/2015
L36021 Molecular Diagnostic Tests (MDT)-CGS Administrators, LLC 10/01/2015
L36035 Spinal Cord Stimulation for Chronic Pain-First Coast Service Options, Inc. 10/01/2015
L36074 MolDX: Molecular RBC Phenotyping-Palmetto GBA 10/01/2015
L36089 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Palmetto GBA 10/01/2015
L36092 Flow Cytometry-Noridian Healthcare Solutions, LLC 10/01/2015
L36093 Flow Cytometry-Noridian Healthcare Solutions, LLC 10/01/2015
L36094 Flow Cytometry-Noridian Healthcare Solutions, LLC 10/01/2015
L36109 Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift®)-Palmetto GBA 10/01/2015
L36125 MolDX: Breast Cancer Assay: Prosigna -Palmetto GBA 10/01/2015
L36143 MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-Palmetto GBA 10/01/2015
L36153 MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Palmetto GBA 10/01/2015
L36174 MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-CGS Administrators, LLC 10/01/2015
L36209 Cardiology – non-emergent outpatient testing: exercise stress test, stress echo, MPI SPECT, and cardiac PET-First Coast Service Options, Inc. 10/01/2015
L36217 Non-Covered Services-Noridian Healthcare Solutions, LLC 10/01/2015
L36219 Non Covered Services-Noridian Healthcare Solutions, LLC 10/01/2015
L36236 Autonomic Function Testing-National Government Services, Inc. 10/01/2015
L36237 Amniotic Membrane- Sutureless Placement on the Ocular Surface -First Coast Service Options, Inc. 10/01/2015
L36238 Humanitarian Use Device (HUD) and Humanitarian Device Exemption (HDE) process-First Coast Service Options, Inc. 10/01/2015
L36240 Allergen Immunotherapy -Novitas Solutions, Inc. 10/01/2015
L36241 Allergy Testing-Novitas Solutions, Inc. 10/01/2015
L36256 MolDX: Molecular Diagnostic Tests (MDT)-Noridian Healthcare Solutions, LLC 10/01/2015
L36276 Erythropoiesis Stimulating Agents -First Coast Service Options, Inc. 10/01/2015
L36279 Blepharoplasty, Eyelid Surgery, and Brow Lift-Noridian Healthcare Solutions, LLC 10/01/2015
L36281 Blepharoplasty, Eyelid Surgery, and Brow Lift-Noridian Healthcare Solutions, LLC 10/01/2015
L36286 Blepharoplasty, Eyelid Surgery, and Brow Lift-Noridian Healthcare Solutions, LLC 10/01/2015
L36296 Sacral Neuromodulation-First Coast Service Options, Inc. 10/01/2015
L36309 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L36310 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L36311 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L36312 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Noridian Healthcare Solutions, LLC 10/01/2015
L36313 MolDX: Breast Cancer Index℠ Genetic Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36314 MolDX: Breast Cancer Index℠ Genetic Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36316 MolDX: Breast Cancer Index℠ Genetic Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36321 MolDX: Breast Cancer Index℠ Genetic Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36322 MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC 10/01/2015
L36323 MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC 10/01/2015
L36324 MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC 10/01/2015
L36325 MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC 10/01/2015
L36326 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36327 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36328 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36329 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36342 Screening and Diagnostic Mammography-First Coast Service Options, Inc. 10/01/2015
L36355 Colorectal Cancer Screening-First Coast Service Options, Inc. 10/01/2015
L36356 Bone Mineral Density Studies-First Coast Service Options, Inc. 10/01/2015
L36377 Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities-First Coast Service Options, Inc. 10/01/2015
L36002 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-CGS Administrators, LLC 10/05/2015
L36006 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-CGS Administrators, LLC 10/05/2015
L36011 MolDX: Molecular RBC Phenotyping-CGS Administrators, LLC 10/05/2015
L36029 Controlled Substance Monitoring and Drugs of Abuse Testing-CGS Administrators, LLC 10/05/2015
L36033 MolDX: HLA-B*15:02 Genetic Testing-Palmetto GBA 10/05/2015
L36044 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Palmetto GBA 10/05/2015
L36048 MolDX: HLA-B*15:02 Genetic Testing-CGS Administrators, LLC 10/05/2015
L36082 MolDX: BRCA1 and BRCA2 Genetic Testing-Palmetto GBA 10/05/2015
L36113 MolDX: MGMT Promoter Methylation Analysis-CGS Administrators, LLC 10/05/2015
L36117 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-CGS Administrators, LLC 10/05/2015
L36129 MolDX: Biomarkers in Cardiovascular Risk Assessment-Palmetto GBA 10/05/2015
L36139 MolDX: Biomarkers in Cardiovascular Risk Assessment-CGS Administrators, LLC 10/05/2015
L36206 MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-CGS Administrators, LLC 10/05/2015
L36393 Controlled Substance Monitoring and Drugs of Abuse Testing-First Coast Service Options, Inc. 10/11/2015
L36340 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36341 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36343 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36344 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36345 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36346 Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC 10/15/2015
L36348 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36349 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36350 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36351 Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC 10/15/2015
L36352 Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC 10/15/2015
L36353 Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC 10/15/2015
L36409 Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC 11/07/2015
L36230 Evaluation and Management Services in a Nursing Facility -First Coast Service Options, Inc. 11/15/2015
L36232 Diagnostic Evaluation and Medical Management of Moderate-Severe Dry Eye Disease (DED)-First Coast Service Options, Inc. 11/22/2015
L34265 Medicine: Nerve Conduction Studies (NCS) and Electromyography (EMG)-Cahaba Government Benefit Administrators®, LLC 12/01/2015
L36037 Urine Drug Testing-National Government Services, Inc. 12/01/2015
L36039 Total Joint Arthroplasty-National Government Services, Inc. 12/01/2015
L36084 Surgery: Leadless Cardiac Pacemaker-Cahaba Government Benefit Administrators®, LLC 12/01/2015
L36086 Radiology: Intra-vascular Optical Coherence Tomography-Cahaba Government Benefit Administrators®, LLC 12/01/2015
L36267 Bowel Management Devices-Noridian Administrative Services 12/01/2015
L36234 Special Histochemical Stains & Immunohistochemical Stains -First Coast Service Options, Inc. 12/06/2015
L36000 Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain-Wisconsin Physicians Service Insurance Corporation 12/17/2015
L36427 Wireless Capsule Endoscopy-Palmetto GBA 01/25/2016
L36425 MolDX: Breast Cancer Assay: Prosigna -CGS Administrators, LLC 02/01/2016
L36458 MolDX: Breast Cancer Index℠ Genetic Assay-CGS Administrators, LLC 02/01/2016
L36460 Bone Mass Measurement-CGS Administrators, LLC 02/01/2016
L36483 MolDX: Chromosome 1p/19q Deletion Analysis-Palmetto GBA 02/01/2016
L36487 MolDX: Chromosome 1p/19q deletion analysis-CGS Administrators, LLC 02/01/2016
L36494 Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint-CGS Administrators, LLC 02/01/2016
L36469 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-CGS Administrators, LLC 02/08/2016
L36456 MolDX: BRCA1 and BRCA2 Genetic Testing-CGS Administrators, LLC 02/15/2016
L36464 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Palmetto GBA 02/15/2016
L36471 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Palmetto GBA 02/15/2016
L36485 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-CGS Administrators, LLC 02/15/2016
L36404 Foot Care-Wisconsin Physicians Service Insurance Corporation 02/16/2016
L36599 Treatment of Varicose Veins of the Lower Extremities-Noridian Healthcare Solutions, LLC 03/13/2016
L36402 Allergy Testing -Wisconsin Physicians Service Insurance Corporation 03/18/2016
L36408 Allergy Immunotherapy-Wisconsin Physicians Service Insurance Corporation 03/18/2016
L36145 MolDX: HLA-B*15:02 Genetic Testing-Noridian Healthcare Solutions, LLC 04/01/2016
L36149 MolDX: HLA-B*15:02 Genetic Testing-Noridian Healthcare Solutions, LLC 04/01/2016
L36167 MolDX: Molecular RBC Phenotyping-Noridian Healthcare Solutions, LLC 04/01/2016
L36171 MolDX: Molecular RBC Phenotyping-Noridian Healthcare Solutions, LLC 04/01/2016
L36376 Genomic Sequence Analysis Panels in the Treatment of Non-Small Cell Lung Cancer-National Government Services, Inc. 04/01/2016
L36406 Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint-National Government Services, Inc. 04/01/2016
L36444 Pathology and Laboratory: Molecular RBC Phenotype-Cahaba Government Benefit Administrators®, LLC 04/01/2016
L36446 Pathology and Laboratory: Partial Genome Profiling in Non Small Cell Lung Cancer (NSCLC)-Cahaba Government Benefit Administrators®, LLC 04/01/2016
L36419 Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure -Novitas Solutions, Inc. 04/07/2016
L36423 Strapping-Novitas Solutions, Inc. 04/07/2016
L36434 Microvascular Therapy-Novitas Solutions, Inc. 04/07/2016
L36499 BRCA1 and BRCA2 Genetic Testing-First Coast Service Options, Inc. 04/11/2016
L36504 Hyperbaric Oxygen (HBO) Therapy -First Coast Service Options, Inc. 04/11/2016
L36634 In Vitro Chemosensitivity & Chemoresistance Assays -Novitas Solutions, Inc. 04/11/2016
L36161 MolDX: BRCA1 and BRCA2 Genetic Testing-Noridian Healthcare Solutions, LLC 04/15/2016
L36163 MolDX: BRCA1 and BRCA2 Genetic Testing-Noridian Healthcare Solutions, LLC 04/15/2016
L36188 MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC 04/15/2016
L36192 MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC 04/15/2016
L36194 MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-Noridian Healthcare Solutions, LLC 04/15/2016
L36198 MolDX- CDD: NSCLC, Comprehensive Genomic Profile Testing-Noridian Healthcare Solutions, LLC 04/15/2016
L36398 MolDX: Genetic Testing for CYP2C19, CYP2D6, CYP2C9, and VKORC1 -Wisconsin Physicians Service Insurance Corporation 04/16/2016
L36400 MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Wisconsin Physicians Service Insurance Corporation 04/16/2016
L36180 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Noridian Healthcare Solutions, LLC 04/19/2016
L36186 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Noridian Healthcare Solutions, LLC 04/19/2016
L36380 MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC 05/03/2016
L36386 MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC 05/03/2016
L36466 Application of Skin Substitutes-Palmetto GBA 05/17/2016
L36204 Spinal Cord Stimulators for Chronic Pain-Noridian Healthcare Solutions, LLC 06/01/2016
L36358 MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC 06/01/2016
L36362 MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC 06/01/2016
L36370 MolDX: Genetic Testing for Lynch Syndrome-Noridian Healthcare Solutions, LLC 06/01/2016
L36374 MolDX: Genetic Testing for Lynch Syndrome-Noridian Healthcare Solutions, LLC 06/01/2016
L36524 Nerve Conduction Studies and Electromyography-Noridian Healthcare Solutions, LLC 06/01/2016
L36526 Nerve Conduction Studies and Electromyography-Noridian Healthcare Solutions, LLC 06/01/2016
L36593 Polysomnography-Palmetto GBA 06/13/2016
L36155 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Noridian Healthcare Solutions, LLC 06/16/2016
L36159 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Noridian Healthcare Solutions, LLC 06/16/2016
L36521 Lumbar Epidural Injections-Wisconsin Physicians Service Insurance Corporation 06/16/2016
L36523 MolDX: Biomarkers in Cardiovascular Risk Assessment-Wisconsin Physicians Service Insurance Corporation 06/16/2016
L36668 Controlled Substance Monitoring and Drugs of Abuse Testing-Noridian Healthcare Solutions, LLC 06/28/2016
L36707 Controlled Substance Monitoring and Drugs of Abuse Testing-Noridian Healthcare Solutions, LLC 06/28/2016
L36601 Prostatic Urethral Lift (PUL)-National Government Services, Inc. 07/01/2016
L36335 MolDX: NRAS Genetic Testing-Noridian Healthcare Solutions, LLC 07/05/2016
L36339 MolDX: NRAS Genetic Testing-Noridian Healthcare Solutions, LLC 07/05/2016
L36364 MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Noridian Healthcare Solutions, LLC 07/05/2016
L36368 MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Noridian Healthcare Solutions, LLC 07/05/2016
L36538 Treatment of Males with Low Testosterone-Noridian Healthcare Solutions, LLC 07/12/2016
L36569 Treatment of Males with Low Testosterone-Noridian Healthcare Solutions, LLC 07/12/2016
L36542 MolDX: Chromosome 1p/19q Deletion Analysis-Noridian Healthcare Solutions, LLC 08/01/2016
L36557 MolDX: Chromosome 1p/19q Deletion Analysis-Noridian Healthcare Solutions, LLC 08/01/2016
L36582 Pathology and Laboratory: K-ras Testing prior to Treatment of Colorectal Cancer (CRC)-Cahaba Government Benefit Administrators®, LLC 08/01/2016
L36573 Total Hip Arthroplasty-Noridian Healthcare Solutions, LLC 09/07/2016
L36575 Total Knee Arthroplasty-Noridian Healthcare Solutions, LLC 09/07/2016
L36577 Total Knee Arthroplasty-Noridian Healthcare Solutions, LLC 09/07/2016
L36617 Chiropractic Services-First Coast Service Options, Inc. 09/12/2016
L36544 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Noridian Healthcare Solutions, LLC 09/15/2016
L36551 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Noridian Healthcare Solutions, LLC 09/15/2016
L36741 Pathology and Laboratory: BRCA1 and BRCA2 Genetic Testing-Cahaba Government Benefit Administrators®, LLC 10/01/2016
L36743 Radiology: Intensity Modulated Radiation Therapy (IMRT)-Cahaba Government Benefit Administrators®, LLC 10/01/2016
L36745 Medicine: Home Sleep Testing (HST)-Cahaba Government Benefit Administrators®, LLC 10/01/2016
L36598 White Cell Colony Stimulating Factors-Palmetto GBA 10/10/2016
L36656 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-CGS Administrators, LLC 10/10/2016
L36665 MolDX- CDD: ProMark Risk Score-Palmetto GBA 10/10/2016
L36675 MolDX- CDD: ProMark Risk Score-CGS Administrators, LLC 10/10/2016
L36690 Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities-CGS Administrators, LLC 10/10/2016
L36761 GlycoMark Testing for Glycemic Control-Palmetto GBA 10/17/2016
L36658 Proton Beam Therapy-CGS Administrators, LLC 10/24/2016
L36767 Aortography and peripheral angiography-First Coast Service Options, Inc. 10/31/2016
L36775 Prostatic Urethral Lift (PUL)-First Coast Service Options, Inc. 10/31/2016
L36749 Air Ambulance Services-National Government Services, Inc. 11/01/2016
L36773 Intensity Modulated Radiation Therapy (IMRT) -First Coast Service Options, Inc. 11/07/2016
L36763 MolDX: 4Kscore Assay-Palmetto GBA 11/21/2016
L36711 Intensity Modulated Radiation Therapy (IMRT)-Novitas Solutions, Inc. 12/01/2016
L36713 Corus® CAD Test-Novitas Solutions, Inc. 12/01/2016
L36715 BRCA1 and BRCA2 Genetic Testing-Novitas Solutions, Inc. 12/01/2016
L36926 Genomic Sequence Analysis Panels in the Treatment of Acute Myelogenous Leukemia (AML)-National Government Services, Inc. 02/01/2017
L36692 Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC 02/03/2017
L36785 MolDX: Breast Cancer Index℠ Genetic Assay-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36787 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay -Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36789 MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36791 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay -Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36793 MolDX: Genetic Testing for Lynch Syndrome-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36795 MolDX: Molecular RBC Phenotyping-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36797 MolDX: NRAS Genetic Testing-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36799 MolDX: GeneSight® Assay for Refractory Depression-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36801 MolDX: HLA-B*15:02 Genetic Testing-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36803 MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36805 Special Histochemical Stains and Immunohistochemical Stains-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36807 MolDX: Molecular Diagnostic Tests (MDT)-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36811 MolDX: Breast Cancer Assay: Prosigna-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36813 MolDX: BRCA1 and BRCA2 Genetic Testing-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36815 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36839 Polysomnography and Other Sleep Studies-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36879 Surgery: Spinal Cord Stimulators for Chronic Pain-Cahaba Government Benefit Administrators®, LLC 03/01/2017
L36945 Medicine: Bioimpedance Spectroscopy (BIS) Devices for the Detection and Management of Lymphedema-Cahaba Government Benefit Administrators®, LLC 03/01/2017
L36902 Polysomnography and Other Sleep Studies-CGS Administrators, LLC 03/06/2017
L36906 GlycoMark Testing for Glycemic Control-CGS Administrators, LLC 03/06/2017
L36912 MolDX - CDD: Oncotype DX ® Breast Cancer for DCIS (Genomic Health ™)-Palmetto GBA 03/06/2017
L36951 MolDX - CDD: Oncotype DX® Breast Cancer for DCIS (Genomic Health ™)-CGS Administrators, LLC 03/06/2017
L36973 Circulating Tumor Cell Marker Assays-CGS Administrators, LLC 03/06/2017
L36975 Bladder/Urothelial Tumor Markers-CGS Administrators, LLC 03/06/2017
L36700 Serum Magnesium-Noridian Healthcare Solutions, LLC 03/13/2017
L36702 Serum Magnesium-Noridian Healthcare Solutions, LLC 03/13/2017
L36827 MolDX: APC and MUTYH Gene Testing -Palmetto GBA 03/13/2017
L36854 MolDX-CDD: Percepta© Bronchial Genomic Classifier-Palmetto GBA 03/13/2017
L36979 MolDX: 4Kscore Assay-CGS Administrators, LLC 03/13/2017
L36831 Visual Electrophysiology Testing -National Government Services, Inc. 03/16/2017
L36941 MolDX - CDD: Oncotype DX® Breast Cancer for DCIS (Genomic Health ™)-Noridian Healthcare Solutions, LLC 03/27/2017
L36947 MolDX - CDD: Oncotype DX® Breast Cancer for DCIS (Genomic Health ™)-Noridian Healthcare Solutions, LLC 03/27/2017
L36850 Peripheral Nerve Blocks-National Government Services, Inc. 05/01/2017
L36920 Epidural Injections for Pain Management -Novitas Solutions, Inc. 05/04/2017
L36882 MolDX: APC and MUTYH Gene Testing -Noridian Healthcare Solutions, LLC 05/15/2017
L36884 MolDX: APC and MUTYH Gene Testing -Noridian Healthcare Solutions, LLC 05/15/2017
L36886 MolDX-CDD: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC 05/15/2017
L36891 MolDX-CDD: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC 05/15/2017
L36678 Bladder/Urothelial Tumor Markers-Noridian Healthcare Solutions, LLC 05/16/2017
L36680 Bladder/Urothelial Tumor Markers-Noridian Healthcare Solutions, LLC 05/16/2017
L36859 Trigger Point Injections-Noridian Healthcare Solutions, LLC 05/26/2017
L36704 MolDX- CDD: ProMark Risk Score-Noridian Healthcare Solutions, LLC 06/01/2017
L36706 MolDX-CDD: ProMark Risk Score-Noridian Healthcare Solutions, LLC 06/01/2017
L36861 Polysomnography and Other Sleep Studies-Noridian Healthcare Solutions, LLC 06/05/2017
L36954 Noncovered Services other than CPT® Category III Noncovered Services-Palmetto GBA 06/05/2017
L37176 White Cell Colony Stimulating Factors-Palmetto GBA 06/12/2017
L37022 Coenzyme Q10 (CoQ10)-Palmetto GBA 07/10/2017
L37031 MolDX: Xpresys Lung -Palmetto GBA 07/10/2017
L37033 MolDX: DecisionDx-UM (Uveal Melanoma)-Palmetto GBA 07/10/2017
L37035 MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Palmetto GBA 07/10/2017
L37043 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Palmetto GBA 07/10/2017
L37126 Coenzyme Q10 (CoQ10)-CGS Administrators, LLC 07/10/2017
L37130 MolDX: DecisionDx-UM (Uveal Melanoma)-CGS Administrators, LLC 07/10/2017
L37134 MolDX: Xpresys Lung -CGS Administrators, LLC 07/10/2017
L37140 MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-CGS Administrators, LLC 07/10/2017
L37142 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-CGS Administrators, LLC 07/10/2017
L36868 Diagnostic and Therapeutic Colonoscopy -Noridian Healthcare Solutions, LLC 07/17/2017
L36889 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC 07/17/2017
L37001 MolDX: MGMT Promoter Methylation Analysis-Wisconsin Physicians Service Insurance Corporation 07/17/2017
L37003 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Wisconsin Physicians Service Insurance Corporation 07/17/2017
L37005 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Wisconsin Physicians Service Insurance Corporation 07/17/2017
L37009 MolDX: Chromosome 1p/19q Deletion Analysis-Wisconsin Physicians Service Insurance Corporation 07/17/2017
L37011 MolDX-CDD: ProMark Risk Score-Wisconsin Physicians Service Insurance Corporation 07/17/2017
L37013 MolDX: 4Kscore Assay-Wisconsin Physicians Service Insurance Corporation 07/17/2017
L37015 Visual Electrophysiology Testing-Wisconsin Physicians Service Insurance Corporation 07/17/2017
L36846 Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC 07/21/2017
L36857 Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC 07/21/2017
L36962 Vascular Endothelial Growth Factor Inhibitors for the Treatment of Ophthalmological Diseases -First Coast Service Options, Inc. 07/24/2017
L36864 GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC 08/01/2017
L36866 GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC 08/01/2017


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