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LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule

2020 (July)
2019

Physician Fee Schedule

2020
2019

OPPS Fee Schedule

2020-October
2020-July

ASC Fee Schedule

2020-October
2020-July

APC Codes

2020-October
2020-July

DRG Codes

2020
2019

ASP Drug Pricing Files

October 2020
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CMS Transmittals



Fall 2020 Webinar Series Announcement-Click here for details

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
L37999 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-Noridian Healthcare Solutions, LLC
L38000 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-Noridian Healthcare Solutions, LLC
L38027 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Palmetto GBA
L38040 MolDX: Prospera -Palmetto GBA
L38042 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Solid Tumors-Palmetto GBA
L38044 MolDX: Next-Generation Sequencing for Solid Tumors-Palmetto GBA
L38046 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Palmetto GBA
L38050 MolDX: Pigmented Lesion Assay-Palmetto GBA
L38058 MolDX: Prospera-CGS Administrators, LLC
L38064 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Solid Tumors-CGS Administrators, LLC
L38066 MolDX: Next-Generation Sequencing for Solid Tumors-CGS Administrators, LLC
L38069 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-CGS Administrators, LLC
L38076 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Unfavorable Intermediate Risk Disease-CGS Administrators, LLC
L38110 MolDX: Pigmented Lesion Assay-CGS Administrators, LLC
L38118 MolDX: Next-Generation Sequencing for Solid Tumors-Noridian Healthcare Solutions, LLC
L38120 MolDX: Next-Generation Sequencing for Solid Tumors-Noridian Healthcare Solutions, LLC
L38122 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Noridian Healthcare Solutions, LLC
L38124 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Noridian Healthcare Solutions, LLC
L38138 Lab: Drug Interaction Testing-Noridian Healthcare Solutions, LLC
L38146 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Unfavorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC
L38148 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Unfavorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC
L38150 MolDX: Pigmented Lesion Assay-Noridian Healthcare Solutions, LLC
L38152 MolDX: Pigmented Lesion Assay-Noridian Healthcare Solutions, LLC
L38154 Lab: Drug Interaction Testing-Noridian Healthcare Solutions, LLC
L38157 MolDX: Next-Generation Sequencing for Solid Tumors-Wisconsin Physicians Service Insurance Corporation
L38165 MolDX:Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Unfavorable Intermediate Risk Disease-Wisconsin Physicians Service Insurance Corporation
L38167 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Solid Tumors-Wisconsin Physicians Service Insurance Corporation
L38173 MolDx: Prospera-Wisconsin Physicians Service Insurance Corporation
L38175 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Wisconsin Physicians Service Insurance Corporation
L38177 MolDX: Pigmented Lesion Assay-Wisconsin Physicians Service Insurance Corporation
L38221 Vertebroplasty/Kyphoplasty-Palmetto GBA
L38237 MolDX: Razor 14-Gene Lung Cancer Assay-Palmetto GBA
L38239 MolDX: Erythrocyte Molecular Antigen Typing-Palmetto GBA
L38248 MolDX: Erythrocyte Molecular Antigen Typing-CGS Administrators, LLC
L38250 Micro-Invasive Glaucoma Surgery (MIGS) -Palmetto GBA
L38253 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-Palmetto GBA
L38254 MolDX: AlloSure® Cell-Free DNA Testing-Palmetto GBA
L38256 MolDX: DecisionDx-Melanoma -Palmetto GBA
L38261 Salvage High-intensity Focused Ultrasound (HIFU) Treatment in Prostate Cancer (PCa)-National Government Services, Inc.
L38265 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-CGS Administrators, LLC
L38266 MolDX: DecisionDx-Melanoma -CGS Administrators, LLC
L38267 Immune Thrombocytopenia (ITP) Therapy-CGS Administrators, LLC
L38271 MolDX: AlloSure® Cell-Free DNA Testing-CGS Administrators, LLC
L38273 MolDX: Repeat Germline Testing-Palmetto GBA
L38275 Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea-Palmetto GBA
L38277 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease-Palmetto GBA
L38283 MolDX: Razor 14-Gene Lung Cancer Assay-CGS Administrators, LLC
L38287 MolDX: Repeat Germline Testing-CGS Administrators, LLC
L38289 MolDX: Signatera and Minimal Residual Disease Testing for Colorectal Cancer-Palmetto GBA
L38291 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate Risk Disease-Palmetto GBA
L38293 MolDX: Pharmacogenomics Testing-Palmetto GBA
L38298 Micro-Invasive Glaucoma Surgery (MIGS) -Noridian Healthcare Solutions, LLC
L38300 Micro-Invasive Glaucoma Surgery (MIGS) -Noridian Healthcare Solutions, LLC
L38302 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate Risk Disease-CGS Administrators, LLC
L38304 MolDX: Signatera and Minimal Residual Disease Testing for Colorectal Cancer-CGS Administrators, LLC
L38306 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea -CGS Administrators, LLC
L38309 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Noridian Healthcare Solutions, LLC
L38311 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Noridian Healthcare Solutions, LLC
L38313 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor-Palmetto GBA
L38326 MolDX: Razor 14-Gene Lung Cancer Assay-Noridian Healthcare Solutions, LLC
L38328 MolDX: Razor 14-Gene Lung Cancer Assay-Noridian Healthcare Solutions, LLC
L38330 MolDX: Erythrocyte Molecular Antigen Typing-Noridian Healthcare Solutions, LLC
L38332 MolDX: Erythrocyte Molecular Antigen Typing-Noridian Healthcare Solutions, LLC
L38334 MolDX: Pharmacogenomics Testing-Noridian Healthcare Solutions, LLC
L38336 MolDX: Pharmacogenomics Testing-Noridian Healthcare Solutions, LLC
L38338 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC
L38340 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC
L38350 MolDX: Repeat Germline Testing-Noridian Healthcare Solutions, LLC
L38352 MolDX: Repeat Germline Testing-Noridian Healthcare Solutions, LLC
L38354 MolDX: AlloSure® Cell-Free DNA Testing-Noridian Healthcare Solutions, LLC
L38360 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-Noridian Healthcare Solutions, LLC
L38361 MolDX: DecisionDx-Melanoma -Noridian Healthcare Solutions, LLC
L38362 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-Noridian Healthcare Solutions, LLC
L38363 MolDX: DecisionDx-Melanoma -Noridian Healthcare Solutions, LLC
L38366 Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)-National Government Services, Inc.
L38370 Multimarker Serum Tests Related to Ovarian Cancer Testing-National Government Services, Inc.
L38377 Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)-CGS Administrators, LLC
L38379 MolDX: AlloSure® Cell-Free DNA Testing-Noridian Healthcare Solutions, LLC
L38383 Select Minimally Invasive GERD Procedures-National Government Services, Inc.
L38384 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Novitas Solutions, Inc.
L38386 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-National Government Services, Inc.
L38388 Biomarkers for Oncology-Novitas Solutions, Inc.
L38393 MolDX: Pharmacogenomics Testing-CGS Administrators, LLC
L38395 Cardiology Non-emergent Outpatient Stress Testing-First Coast Service Options, Inc.
L38397 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-First Coast Service Options, Inc.
L38399 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-National Government Services, Inc.
L38428 MolDX: Repeat Germline Testing-Wisconsin Physicians Service Insurance Corporation
L38430 MolDX: Signatera and Minimal Residual Disease Testing for Colorectal Cancer-Wisconsin Physicians Service Insurance Corporation
L38432 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate Risk Disease-Wisconsin Physicians Service Insurance Corporation
L38434 MolDX: Pharmacogenomics Testing-Wisconsin Physicians Service Insurance Corporation
L38438 MolDX: AlloSure® Cell-Free DNA Testing-Wisconsin Physicians Service Insurance Corporation
L38440 MolDX: Erythrocyte Molecular Antigen Typing-Wisconsin Physicians Service Insurance Corporation
L38442 MolDX Razor 14-Gene Lung Cancer Assay-Wisconsin Physicians Service Insurance Corporation
L38445 Category III Codes-Wisconsin Physicians Service Insurance Corporation
L38446 Erythropoiesis Stimulating Agents (ESAs)-Wisconsin Physicians Service Insurance Corporation
L38447 Wound Care-Wisconsin Physicians Service Insurance Corporation
L38448 MolDX: DecisionDX-Melanoma-Wisconsin Physicians Service Insurance Corporation
L38450 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-Wisconsin Physicians Service Insurance Corporation
L38459 Thrombolytic Agents-Novitas Solutions, Inc.
L38474 Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-First Coast Service Options, Inc.
L38480 Prostate Rectal Spacers-National Government Services, Inc.
L38491 Vitamin D Assay Testing-CGS Administrators, LLC
L38493 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)-Novitas Solutions, Inc.
L38494 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor-Novitas Solutions, Inc.
L38496 Nebulizers-Noridian Administrative Services
L38499 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)-First Coast Service Options, Inc.
L38505 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor-First Coast Service Options, Inc.
L38507 Oxygen and Oxygen Equipment-Noridian Administrative Services
L38508 External Infusion Pumps-Noridian Administrative Services
L38523 Transcranial Magnetic Stimulation-National Government Services, Inc.
L38524 Urological Supplies-Noridian Administrative Services
L38527 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Wisconsin Physicians Service Insurance Corporation
L38529 MolDX: Circulating Tumor Cell Marker Assays-Wisconsin Physicians Service Insurance Corporation
L38536 Water Vapor Thermal Therapy for LUTS/BPH-National Government Services, Inc.
L38548 Fluid Jet System in the Treatment of Benign Prostatic Hypertrophy (BPH)-Palmetto GBA
L38550 Transanal Endoscopic Surgery (TES)-Palmetto GBA
L38558 Stretta Procedure-Palmetto GBA
L38560 MolDX: EndoPredict Breast Cancer Gene Expression Test-Palmetto GBA
L38565 MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells-Palmetto GBA
L38567 MolDX: Liquid Biopsies for Solid Organ Transplantation-Palmetto GBA
L38569 MolDX: Breast Cancer Index™ (BCI) Gene Expression Test-Palmetto GBA
L38570 Colon Capsule Endoscopy (CCE)-National Government Services, Inc.
L38572 Percutaneous Arteriovenous Fistula (pAVF) for Hemodialysis-National Government Services, Inc.
L38574 Intravenous Immunoglobulin (IVIG)-Palmetto GBA
L38575 MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer-Palmetto GBA
L38581 MolDX: Liquid Biopsies for Solid Organ Transplantation-CGS Administrators, LLC
L38583 MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells-CGS Administrators, LLC
L38585 MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer-CGS Administrators, LLC
L38587 MolDX: EndoPredict Breast Cancer Gene Expression Test-CGS Administrators, LLC
L38588 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test-CGS Administrators, LLC
L38593 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-National Government Services, Inc.
L38612 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease-Noridian Healthcare Solutions, LLC
L38614 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease-Noridian Healthcare Solutions, LLC
L38616 Implantable Continuous Glucose Monitors (I-CGM)-Novitas Solutions, Inc.
L38622 Implantable Continuous Glucose Monitors (I-CGM)-National Government Services, Inc.
L38628 MolDX: Liquid Biopsies for Solid Organ Transplantation-Noridian Healthcare Solutions, LLC
L38630 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test-Noridian Healthcare Solutions, LLC
L38631 MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC
L38632 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test-Noridian Healthcare Solutions, LLC
L38633 MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC
L38640 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-Noridian Healthcare Solutions, LLC
L38641 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-Noridian Healthcare Solutions, LLC
L38642 MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells-Noridian Healthcare Solutions, LLC
L38644 MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells-Noridian Healthcare Solutions, LLC
L38646 MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer-Noridian Healthcare Solutions, LLC
L38648 MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer-Noridian Healthcare Solutions, LLC
L38656 Implantable Continuous Glucose Monitors (I-CGM)-Noridian Healthcare Solutions, LLC
L38658 Implantable Continuous Glucose Monitors (I-CGM)-Noridian Healthcare Solutions, LLC
L38660 External Infusion Pumps-Noridian Administrative Services
L38661 Implantable Continuous Glucose Monitors (I-CGM)-CGS Administrators, LLC
L38663 Implantable Continuous Glucose Monitors (I-CGM)-First Coast Service Options, Inc.
L38665 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-CGS Administrators, LLC
L38666 Computed Tomography Cerebral Perfusion Analysis (CTP)-National Government Services, Inc.
L38670 MolDX: Liquid Biopsies for Solid Organ Transplantation-Noridian Healthcare Solutions, LLC
L38674 MolDX: Breast Cancer Index™ (BCI) Gene Expression Test-Wisconsin Physicians Service Insurance Corporation
L38675 MolDX: EndoPredict® Breast Cancer Gene Expression Test-Wisconsin Physicians Service Insurance Corporation
L38677 MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells-Wisconsin Physicians Service Insurance Corporation
L38679 MolDx: Liquid Biopsies for Solid Organ Transplantation-Wisconsin Physicians Service Insurance Corporation
L38681 Fluid Jet System Treatment for LUTS/BPH-Wisconsin Physicians Service Insurance Corporation
L38683 MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer-Wisconsin Physicians Service Insurance Corporation
L38685 Implantable Continuous Glucose Monitors (I-CGM)-Wisconsin Physicians Service Insurance Corporation
L38693 Computed Tomography Cerebral Perfusion Analysis (CTP)-CGS Administrators, LLC
L38699 Computed Tomography Cerebral Perfusion Analysis (CTP)-Noridian Healthcare Solutions, LLC
L38704 Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia-Noridian Healthcare Solutions, LLC
L38706 Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia-Noridian Healthcare Solutions, LLC
L38708 Computed Tomography Cerebral Perfusion Analysis (CTP)-Noridian Healthcare Solutions, LLC
L38711 Transuretheral Waterjet Ablation of the Prostate-Novitas Solutions, Inc.
L38713 Endovenous Stenting-Novitas Solutions, Inc.
L38716 Treatment of Chronic Venous Insufficiency of the Lower Extremities-Novitas Solutions, Inc.
L38719 Treatment of Chronic Venous Insufficiency of the Lower Extremities-First Coast Service Options, Inc.
L38725 Transurethral Waterjet Ablation of the Prostate-First Coast Service Options, Inc.
L38729 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor-National Government Services, Inc.
L38730 Endovenous Stenting-First Coast Service Options, Inc.
L38735 Heavy Metal Testing-National Government Services, Inc.
L38736 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-Palmetto GBA
L38742 Implantable Continuous Glucose Monitors (I-CGM)-Palmetto GBA
L38744 Platelet Rich Plasma-Palmetto GBA
L38746 Peroral Endoscopic Myotomy (POEM)-Palmetto GBA
L38753 Controlled Substance Monitoring and Drugs of Abuse Testing-CGS Administrators, LLC
L38754 Colon Capsule Endoscopy (CCE)-Palmetto GBA
L38756 Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions-CGS Administrators, LLC
L38757 Select Minimally Invasive GERD Procedures-National Government Services, Inc.
L38764 Facet Joint Interventions for Pain Management-Palmetto GBA
L38768 Computed Tomography Cerebral Perfusion Analysis (CTP)-Palmetto GBA
L38770 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease-CGS Administrators, LLC
L38772 Facet Joint Interventions for Pain Management-CGS Administrators, LLC
L38774 Extracorporeal Shock Wave Therapy (ESWT)-Palmetto GBA
L38776 Colon Capsule Endoscopy (CCE)-CGS Administrators, LLC
L38778 MolDX: Minimal Residual Disease Testing for Cancer-Palmetto GBA
L38785 Echocardiography for Myocardial Perfusion-Palmetto GBA
L38788 Facet Joint Interventions for Pain Management-National Government Services, Inc.
L38791 Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza®)-Palmetto GBA
L38800 Facet Joint Interventions for Pain Management-Noridian Healthcare Solutions, LLC
L38802 Facet Joint Interventions for Pain Management-Noridian Healthcare Solutions, LLC
L38804 Colon Capsule Endoscopy (CCE)-First Coast Service Options, Inc.
L38806 Colon Capsule Endoscopy (CCE)-Novitas Solutions, Inc.
L38808 Botulinum Toxins-Novitas Solutions, Inc.
L38810 Blepharoplasty and Surgical Procedures of the Brow-Novitas Solutions, Inc.
L38811 Diagnostic Colonoscopy-Novitas Solutions, Inc.
L38813 MolDX: Minimal Residual Disease Testing for Cancer-Noridian Healthcare Solutions, LLC
L38815 MolDX: Minimal Residual Disease Testing for Cancer-Noridian Healthcare Solutions, LLC
L38821 MolDX: Minimal Residual Disease Testing for Cancer-CGS Administrators, LLC
L38823 Colon Capsule Endoscopy (CCE)-Noridian Healthcare Solutions, LLC
L38825 Colon Capsule Endoscopy (CCE)-Noridian Healthcare Solutions, LLC
L38827 Diagnostic Colonoscopy-First Coast Service Options, Inc.
L38828 Botulinum Toxins-First Coast Service Options, Inc.
L38829 Blepharoplasty and Surgical Procedures of the Brow-First Coast Service Options, Inc.
L38833 Endoscopic Treatment of GERD-Wisconsin Physicians Service Insurance Corporation
L38834 MolDX: Minimal Residual Disease Testing for Cancer-Wisconsin Physicians Service Insurance Corporation
L38836 Colon Capsule Endoscopy (CCE)-Wisconsin Physicians Service Insurance Corporation
L38838 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease-Wisconsin Physicians Service Insurance Corporation
L38840 Facet Joint Interventions for Pain Management-Wisconsin Physicians Service Insurance Corporation
L38842 Cardiology Non-emergent Outpatient Stress Testing-First Coast Service Options, Inc.
L38845 Cardiology Non-emergent Outpatient Stress Testing-Novitas Solutions, Inc.
L38849 Facet Joint Interventions for Pain Management-Novitas Solutions, Inc.
L38850 Facet Joint Interventions for Pain Management-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
L33261 Allergy Testing-First Coast Service Options, Inc. 10/01/2015
L33267 B-Type Natriuretic Peptide (BNP)-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
L33274 Botulinum Toxins-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
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
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
L33380 Long-Term Wearable Electrocardiographic Monitoring (WEM)-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
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 – Ambulatory 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
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
L33413 Therapy and Rehabilitation Services-First Coast Service Options, Inc. 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 Lab: 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
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
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
L33467 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography-Palmetto GBA 10/01/2015
L33473 Vertebroplasty/Kyphoplasty-Palmetto GBA 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
L33567 Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)-National Government Services, Inc. 10/01/2015
L33569 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-National Government Services, 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
L33591 RAST Type Tests-National Government Services, Inc. 10/01/2015
L33594 Manipulation Under Anesthesia (MUA)-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
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-First Coast Service Options, Inc. 10/01/2015
L33707 Pulmonary Diagnostic Services-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
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
L33747 Pegfilgrastim-First Coast Service Options, Inc. 10/01/2015
L33751 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-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
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
L33810 Computerized Corneal Topography-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
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
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
L33903 Diagnostic Laryngoscopy-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
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
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-First Coast Service Options, Inc. 10/01/2015
L33925 Ophthalmological Diagnostic Services-First Coast Service Options, Inc. 10/01/2015
L33927 Optical Coherence Biometry-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
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
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
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 B12 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
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
L33979 Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)-Noridian Healthcare Solutions, LLC 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
L33999 Corneal Pachymetry-CGS Administrators, LLC 10/01/2015
L34002 G-CSF Filgrastim-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
L34014 Magnesium-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
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 – Trastuzumab Biologics-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
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
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
L34055 Virtual Colonoscopy (CT Colonography)-CGS Administrators, LLC 10/01/2015
L34056 Urodynamics-CGS Administrators, 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 MolDX: Circulating Tumor Cell Marker Assays-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
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
L34093 Chemotherapy and Biologicals-CGS Administrators, LLC 10/01/2015
L34106 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-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
L34163 Total Hip Arthroplasty-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
L34181 Ophthalmic Biometry for Intraocular Lens Power Calculation-CGS Administrators, LLC 10/01/2015
L34183 Psychiatric Inpatient Hospitalization-CGS Administrators, 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
L34203 Cataract Surgery in Adults-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 Lab: Flow Cytometry-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
L34228 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-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
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
L34324 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC 10/01/2015
L34328 Peripheral Nerve 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
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
L34413 Cataract Surgery-Palmetto GBA 10/01/2015
L34415 CT of the Abdomen and Pelvis-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
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
L34454 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-Palmetto GBA 10/01/2015
L34512 Corneal Pachymetry-Palmetto GBA 10/01/2015
L34513 Lab: 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
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
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
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
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 Hemodialysis-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
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
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
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
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
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
L34859 Nerve Conduction Studies and Electromyography-First Coast Service Options, Inc. 10/01/2015
L34862 Co-Management of Surgical Procedures-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
L34887 Surgical Treatment of Nails-Novitas Solutions, Inc. 10/01/2015
L34891 Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy-Novitas Solutions, Inc. 10/01/2015
L34892 Facet Joint Interventions for Pain Management-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 Chronic Venous Insufficiency of the Lower Extremities-Novitas Solutions, Inc. 10/01/2015
L34938 Removal of Benign Skin Lesions-Novitas Solutions, Inc. 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
L34975 Neurophysiology Evoked Potentials (NEPs)-Novitas Solutions, Inc. 10/01/2015
L34976 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)-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
L34982 Lumbar Epidural Injections-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 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder -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 Hemodialysis-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-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
L35032 Flow Cytometry-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
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
L35062 Biomarkers Overview-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 MolDX: 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 Select Minimally Invasive GERD Procedures-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
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
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
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 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)-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
L35136 Spinal Cord Stimulators for Chronic Pain-Noridian Healthcare Solutions, LLC 10/01/2015
L35138 Routine Foot 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 and Neck-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
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
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
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
L35632 MolDX: ConfirmMDx Epigenetic Molecular Assay-Palmetto GBA 10/01/2015
L35633 MolDX: GeneSight® Assay for Refractory Depression-Palmetto GBA 10/01/2015
L35677 Infliximab -Palmetto GBA 10/01/2015
L35698 CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-First Coast Service Options, Inc. 10/01/2015
L35702 Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC 10/01/2015
L35704 Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC 10/01/2015
L35710 MolDX: Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC 10/01/2015
L35724 Lab: 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: Decipher® Prostate Cancer Classifier Assay-Palmetto GBA 10/01/2015
L35869 MolDX: Prolaris™ Prostate Cancer Genomic Assay-Palmetto GBA 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
L35922 Lab: 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
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 MolDX: 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
L36094 Lab: 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
L36153 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Palmetto GBA 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
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
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
L36310 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
L36323 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
L36327 MolDX: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC 10/01/2015
L36329 MolDX: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC 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: Prolaris™ Prostate Cancer Genomic Assay-CGS Administrators, LLC 10/05/2015
L36006 MolDX: 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: 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
L36343 MolDX: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36345 MolDX: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36348 MolDX: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36350 MolDX: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC 10/15/2015
L36351 Lab: Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC 10/15/2015
L36353 Lab: Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC 10/15/2015
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
L36037 Urine Drug Testing-National Government Services, Inc. 12/01/2015
L36039 Total Joint Arthroplasty-National Government Services, Inc. 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
L36460 Bone Mass Measurement-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
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
L36406 Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint-National Government Services, Inc. 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
L36398 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-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
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 Lab:Controlled Substance Monitoring and Drugs of Abuse Testing-Noridian Healthcare Solutions, LLC 06/28/2016
L36707 Lab: Controlled Substance Monitoring and Drugs of Abuse Testing-Noridian Healthcare Solutions, LLC 06/28/2016
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: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Noridian Healthcare Solutions, LLC 07/05/2016
L36368 MolDX: 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
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
L36656 MolDX: Decipher® Prostate Cancer Classifier Assay-CGS Administrators, LLC 10/10/2016
L36665 MolDX: 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
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
L36692 Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC 02/03/2017
L36787 MolDX: Prolaris™ Prostate Cancer Genomic Assay -Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36789 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Wisconsin Physicians Service Insurance Corporation 02/16/2017
L36791 MolDX: 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
L36805 Lab: 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
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: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Palmetto GBA 03/06/2017
L36951 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-CGS Administrators, LLC 03/06/2017
L36973 MolDX: 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: Percepta® Bronchial Genomic Classifier-Palmetto GBA 03/13/2017
L36908 MolDX: Percepta® Bronchial Genomic Classifier-CGS Administrators, LLC 03/13/2017
L36910 MolDX: APC and MUTYH Gene Testing -CGS Administrators, LLC 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: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Noridian Healthcare Solutions, LLC 03/27/2017
L36947 MolDX: 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: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC 05/15/2017
L36891 MolDX: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC 05/15/2017
L36678 Lab: Bladder/Urothelial Tumor Markers-Noridian Healthcare Solutions, LLC 05/16/2017
L36680 Lab: Bladder/Urothelial Tumor Markers-Noridian Healthcare Solutions, LLC 05/16/2017
L36859 Trigger Point Injections-Noridian Healthcare Solutions, LLC 05/26/2017
L36704 MolDX: ProMark Risk Score-Noridian Healthcare Solutions, LLC 06/01/2017
L36706 MolDX: 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 Lab: Coenzyme Q10 (CoQ10)-Palmetto GBA 07/10/2017
L37031 MolDX: BDX-XL2-Palmetto GBA 07/10/2017
L37033 MolDX: DecisionDx-UM (Uveal Melanoma)-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: BDX-XL2-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: ConfirmMDx Epigenetic Molecular Assay-Wisconsin Physicians Service Insurance Corporation 07/17/2017
L37011 MolDX: 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
L37195 MolDX: Percepta® Bronchial Genomic Classifier-Wisconsin Physicians Service Insurance Corporation 09/16/2017
L37199 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Wisconsin Physicians Service Insurance Corporation 09/16/2017
L37205 Chemotherapy Drugs and their Adjuncts-Wisconsin Physicians Service Insurance Corporation 09/16/2017
L37210 MolDX: Decision Dx-UM (Uveal Melanoma)-Wisconsin Physicians Service Insurance Corporation 09/16/2017
L37216 MolDX: BDX-XL2-Wisconsin Physicians Service Insurance Corporation 09/16/2017
L37224 MolDX: APC and MUTYH Gene Testing-Wisconsin Physicians Service Insurance Corporation 09/16/2017
L37226 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Wisconsin Physicians Service Insurance Corporation 09/16/2017
L37379 Echocardiography -Palmetto GBA 09/18/2017
L37070 MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC 09/22/2017
L37072 MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC 09/22/2017
L37080 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC 09/25/2017
L37082 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC 09/25/2017
L37387 Chiropractic Services-Palmetto GBA 09/25/2017
L37260 MolDX: Prometheus IBD sgi Diagnostic Policy-Palmetto GBA 09/26/2017
L37054 MolDX: BDX-XL2-Noridian Healthcare Solutions, LLC 09/29/2017
L37062 MolDX: BDX-XL2-Noridian Healthcare Solutions, LLC 09/29/2017
L37066 Lab: Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC 10/02/2017
L37068 Lab: Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC 10/02/2017
L37262 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Palmetto GBA 10/02/2017
L37264 MolDX: EndoPredict Breast Cancer Gene Expression Test-Palmetto GBA 10/02/2017
L37266 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Palmetto GBA 10/02/2017
L37020 Plastic Surgery-Noridian Healthcare Solutions, LLC 10/10/2017
L37027 Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC 10/10/2017
L37254 Chiropractic Services-CGS Administrators, LLC 11/06/2017
L37352 MolDX: Prometheus IBD sgi Diagnostic Policy-CGS Administrators, LLC 11/06/2017
L37244 Micro-Invasive Glaucoma Surgery (MIGS) -National Government Services, Inc. 12/01/2017
L37166 Wound Care-First Coast Service Options, Inc. 12/07/2017
L37303 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Noridian Healthcare Solutions, LLC 12/11/2017
L37358 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Noridian Healthcare Solutions, LLC 12/11/2017
L37371 Electroretinography (ERG)-Novitas Solutions, Inc. 01/25/2018
L37375 Reflectance Confocal Microscopy-Novitas Solutions, Inc. 01/25/2018
L37632 Spinal Cord Stimulators for Chronic Pain-Palmetto GBA 01/29/2018
L37633 Partial Hospitalization Programs-Palmetto GBA 01/29/2018
L37638 Health and Behavior Assessment/Intervention-Palmetto GBA 01/29/2018
L37641 Continuous Peripheral Nerve Blocks (CPNB)-Palmetto GBA 01/29/2018
L37642 Nerve Blocks and Electrostimulation for Peripheral Neuropathy-Palmetto GBA 01/29/2018
L37643 Routine Foot Care-Palmetto GBA 01/29/2018
L37644 YAG Capsulotomy-Palmetto GBA 01/29/2018
L37295 MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC 01/30/2018
L37299 MolDX: Prometheus IBD sgi Diagnostic Policy-Noridian Healthcare Solutions, LLC 01/30/2018
L37311 MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC 01/30/2018
L37313 MolDX: Prometheus IBD sgi Diagnostic Policy-Noridian Healthcare Solutions, LLC 01/30/2018
L37398 Electroretinography (ERG)-First Coast Service Options, Inc. 02/02/2018
L37561 Cystatin C Measurement-First Coast Service Options, Inc. 02/02/2018
L37635 Trigger Point Injections-Palmetto GBA 02/26/2018
L37636 Nonobstetric Pelvic Ultrasound-Palmetto GBA 02/26/2018
L37354 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-CGS Administrators, LLC 03/06/2018
L37356 MolDX: EndoPredict Breast Cancer Gene Expression Test-CGS Administrators, LLC 03/06/2018
L37362 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-CGS Administrators, LLC 03/06/2018
L37305 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Noridian Healthcare Solutions, LLC 03/18/2018
L37321 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Noridian Healthcare Solutions, LLC 03/18/2018
L37539 MolDX: Prometheus IBD sgi Diagnostic Policy-Wisconsin Physicians Service Insurance Corporation 03/19/2018
L37578 Micro-Invasive Glaucoma Surgery (MIGS)-CGS Administrators, LLC 03/19/2018
L37283 Electrocardiograms-Noridian Healthcare Solutions, LLC 03/26/2018
L37421 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor-National Government Services, Inc. 04/01/2018
L37535 Vitamin D Assay Testing-National Government Services, Inc. 04/01/2018
L37228 Wound Care-Wisconsin Physicians Service Insurance Corporation 04/16/2018
L37086 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Noridian Healthcare Solutions, LLC 05/14/2018
L37088 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Noridian Healthcare Solutions, LLC 05/14/2018
L37547 Chest X-Ray Policy-Noridian Healthcare Solutions, LLC 06/22/2018
L37549 Chest X-Ray Policy-Noridian Healthcare Solutions, LLC 06/22/2018
L37697 Emergency and Non-Emergency Ground Ambulance Services-First Coast Service Options, Inc. 06/28/2018
L37485 Prostate Rectal Spacers-National Government Services, Inc. 07/02/2018
L37293 Respiratory Care (Respiratory Therapy)-Noridian Healthcare Solutions, LLC 07/09/2018
L37606 Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases-National Government Services, Inc. 08/01/2018
L37663 MolDX: EndoPredict® Breast Cancer Gene Expression Test-Wisconsin Physicians Service Insurance Corporation 08/16/2018
L37665 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Wisconsin Physicians Service Insurance Corporation 08/16/2018
L37667 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Wisconsin Physicians Service Insurance Corporation 08/16/2018
L37281 Lumbar MRI-Noridian Healthcare Solutions, LLC 08/27/2018
L37360 Peripheral Nerve Stimulation-Noridian Healthcare Solutions, LLC 08/27/2018
L37699 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) -Palmetto GBA 08/27/2018
L37682 Nusinersen (Spinraza) -Novitas Solutions, Inc. 09/14/2018
L37761 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor-Palmetto GBA 09/24/2018
L37779 Intraoperative Radiation Therapy-Palmetto GBA 09/24/2018
L37628 In Vitro Chemosensitivity & Chemoresistance Assays-Noridian Healthcare Solutions, LLC 10/01/2018
L37630 In Vitro Chemosensitivity & Chemoresistance Assays-Noridian Healthcare Solutions, LLC 10/01/2018
L37790 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor-CGS Administrators, LLC 10/01/2018
L37373 MRI and CT Scans of the Head and Neck-Noridian Healthcare Solutions, LLC 10/08/2018
L37671 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) -Wisconsin Physicians Service Insurance Corporation 10/17/2018
L37800 Allergen Immunotherapy -First Coast Service Options, Inc. 10/18/2018
L37649 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-Noridian Healthcare Solutions, LLC 10/20/2018
L37651 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-Noridian Healthcare Solutions, LLC 10/20/2018
L37612 MolDX: Corus® CAD Assay-Palmetto GBA 11/05/2018
L37713 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Palmetto GBA 11/12/2018
L37787 MolDX: Corus® CAD Assay-CGS Administrators, LLC 11/12/2018
L37366 Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-CGS Administrators, LLC 11/19/2018
L37774 Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication-Palmetto GBA 11/19/2018
L37733 Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis-National Government Services, Inc. 12/01/2018
L37808 Water Vapor Thermal Therapy for LUTS/BPH-National Government Services, Inc. 12/01/2018
L37348 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-CGS Administrators, LLC 12/03/2018
L37581 MolDX: Cystatin C Measurement-Palmetto GBA 12/03/2018
L37725 MolDX: Melanoma Risk Stratification Molecular Testing-Palmetto GBA 12/03/2018
L37701 MolDX: Androgen Receptor Variant (AR-V7) Protein Test-Palmetto GBA 12/10/2018
L37709 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) -Palmetto GBA 12/10/2018
L37598 MolDX: Cystatin C Measurement-CGS Administrators, LLC 12/17/2018
L37764 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Wisconsin Physicians Service Insurance Corporation 12/17/2018
L37768 MolDX: CYSTATIN C Measurement-Wisconsin Physicians Service Insurance Corporation 12/17/2018
L37770 MolDX: CORUS® CAD ASSAY-Wisconsin Physicians Service Insurance Corporation 12/17/2018
L37531 Micro-Invasive Glaucoma Surgery (MIGS) -Palmetto GBA 12/24/2018
L37364 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -CGS Administrators, LLC 01/07/2019
L37120 MolDX: 4Kscore Assay-Noridian Healthcare Solutions, LLC 01/13/2019
L37122 MolDX: 4Kscore Assay-Noridian Healthcare Solutions, LLC 01/13/2019
L37673 MolDX: Corus® CAD Assay-Noridian Healthcare Solutions, LLC 02/10/2019
L37675 MolDX: Corus® CAD Assay-Noridian Healthcare Solutions, LLC 02/10/2019
L37748 MolDX: Melanoma Risk Stratification Molecular Testing-Noridian Healthcare Solutions, LLC 02/10/2019
L37750 MolDX: Melanoma Risk Stratification Molecular Testing-Noridian Healthcare Solutions, LLC 02/10/2019
L37350 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Noridian Healthcare Solutions, LLC 02/11/2019
L37368 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Noridian Healthcare Solutions, LLC 02/11/2019
L37616 MolDX: Cystatin C Measurement-Noridian Healthcare Solutions, LLC 02/11/2019
L37618 MolDX: Cystatin C Measurement-Noridian Healthcare Solutions, LLC 02/11/2019
L37766 Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)-Wisconsin Physicians Service Insurance Corporation 02/16/2019
L37915 MolDX: Androgen Receptor Variant (AR-V7) Protein Test-Wisconsin Physicians Service Insurance Corporation 02/16/2019
L37502 Frequency of Hemodialysis-Noridian Healthcare Solutions, LLC 02/18/2019
L37504 Frequency of Hemodialysis-Noridian Healthcare Solutions, LLC 02/18/2019
L37475 Frequency of Hemodialysis-National Government Services, Inc. 03/01/2019
L37537 Frequency of Hemodialysis-Wisconsin Physicians Service Insurance Corporation 03/01/2019
L37564 Frequency of Hemodialysis-First Coast Service Options, Inc. 03/01/2019
L37744 MolDX: Androgen Receptor Variant (AR-V7) Protein Test-Noridian Healthcare Solutions, LLC 03/02/2019
L37746 MolDX: Androgen Receptor Variant (AR-V7) Protein Test-Noridian Healthcare Solutions, LLC 03/02/2019
L37794 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test -Palmetto GBA 03/11/2019
L37798 4Kscore Test Algorithm-First Coast Service Options, Inc. 03/18/2019
L37792 4Kscore Test Algorithm-Novitas Solutions, Inc. 03/21/2019
L37836 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-CGS Administrators, LLC 03/25/2019
L37575 Frequency of Hemodialysis-CGS Administrators, LLC 04/01/2019
L37729 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor-Noridian Healthcare Solutions, LLC 04/01/2019
L37738 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor-Noridian Healthcare Solutions, LLC 04/01/2019
L37785 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-Palmetto GBA 04/01/2019
L37810 Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms-National Government Services, Inc. 04/01/2019
L37832 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test-CGS Administrators, LLC 04/01/2019
L37851 Biomarker Testing for Neuroendocrine Tumors/Neoplasms-National Government Services, Inc. 04/01/2019
L37857 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-Palmetto GBA 04/01/2019
L37929 Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea-National Government Services, Inc. 04/01/2019
L37602 MolDX: MDS FISH-Palmetto GBA 04/08/2019
L37870 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-Palmetto GBA 04/08/2019
L37913 MolDX: Breast Cancer Index™ (BCI) Gene Expression Test-Wisconsin Physicians Service Insurance Corporation 04/15/2019
L37921 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-Wisconsin Physicians Service Insurance Corporation 04/15/2019
L37822 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test -Noridian Healthcare Solutions, LLC 04/16/2019
L37824 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test -Noridian Healthcare Solutions, LLC 04/16/2019
L37834 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-CGS Administrators, LLC 04/29/2019
L37859 MolDX: myPath Melanoma Assay -Palmetto GBA 04/29/2019
L37608 MolDX: MDS FISH-CGS Administrators, LLC 05/06/2019
L37826 Lumbar Artificial Disc Replacement-Palmetto GBA 05/06/2019
L37848 Lumbar Spinal Fusion-Palmetto GBA 05/06/2019
L37863 Voretigene Neparvovec-rzyl (Luxturna®)-Palmetto GBA 05/06/2019
L37873 Topical Oxygen Therapy -Palmetto GBA 05/06/2019
L37796 Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins-Novitas Solutions, Inc. 05/07/2019
L37301 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Noridian Healthcare Solutions, LLC 05/13/2019
L37315 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Noridian Healthcare Solutions, LLC 05/13/2019
L37772 MolDX: MDS FISH-Wisconsin Physicians Service Insurance Corporation 05/13/2019
L37903 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-CGS Administrators, LLC 05/13/2019
L37911 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-Wisconsin Physicians Service Insurance Corporation 05/13/2019
L37919 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-Wisconsin Physicians Service Insurance Corporation 05/13/2019
L37893 Endovenous Stenting-Novitas Solutions, Inc. 05/20/2019
L37905 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-CGS Administrators, LLC 05/20/2019
L37624 Helicobacter Pylori Infection Testing-Noridian Healthcare Solutions, LLC 05/27/2019
L37626 Helicobacter Pylori Infection Testing-Noridian Healthcare Solutions, LLC 05/27/2019
L37818 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-Noridian Healthcare Solutions, LLC 05/27/2019
L37820 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-Noridian Healthcare Solutions, LLC 05/27/2019
L37887 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-Noridian Healthcare Solutions, LLC 05/27/2019
L37891 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-Noridian Healthcare Solutions, LLC 05/27/2019
L37620 MolDX: MDS FISH-Noridian Healthcare Solutions, LLC 06/03/2019
L37622 MolDX: MDS FISH-Noridian Healthcare Solutions, LLC 06/03/2019
L37879 MolDX: myPath Melanoma Assay -Noridian Healthcare Solutions, LLC 06/03/2019
L37881 MolDX: myPath Melanoma Assay -Noridian Healthcare Solutions, LLC 06/03/2019
L37897 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-Noridian Healthcare Solutions, LLC 06/03/2019
L37899 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-Noridian Healthcare Solutions, LLC 06/03/2019
L37907 MolDX: myPath Melanoma Assay-CGS Administrators, LLC 06/03/2019
L37923 MolDX: myPath Melanoma Assay -Wisconsin Physicians Service Insurance Corporation 06/10/2019
L38016 MolDX: Melanoma Risk Stratification Molecular Testing-CGS Administrators, LLC 06/24/2019
L38014 Corneal Hysteresis-National Government Services, Inc. 08/01/2019
L37943 Anorectal Manometry and Electromyography (EMG) of the Urinary and Anal Sphincters-First Coast Service Options, Inc. 08/12/2019
L38018 MolDX: Melanoma Risk Stratification Molecular Testing-Wisconsin Physicians Service Insurance Corporation 08/12/2019
L38211 Corneal Hysteresis-Wisconsin Physicians Service Insurance Corporation 10/14/2019
L38026 Corneal Hysteresis-Palmetto GBA 10/21/2019
L38033 Cervical Disc Replacement-Palmetto GBA 10/28/2019
L38201 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-CGS Administrators, LLC 11/18/2019
L38039 MolDX: TruGraf Blood Gene Expression Test -Palmetto GBA 11/25/2019
L38160 MolDX: TruGraf® Blood Gene Expression Test-Wisconsin Physicians Service Insurance Corporation 12/16/2019
L38213 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)-Wisconsin Physicians Service Insurance Corporation 12/16/2019
L38053 MolDX: TruGraf Blood Gene Expression Test -CGS Administrators, LLC 12/30/2019
L38223 Micro-Invasive Glaucoma Surgery (MIGS)-Novitas Solutions, Inc. 12/30/2019
L38227 Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)-First Coast Service Options, Inc. 12/30/2019
L38229 Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) -Novitas Solutions, Inc. 12/30/2019
L38231 Endovenous Stenting-First Coast Service Options, Inc. 12/30/2019
L38233 Micro-Invasive Glaucoma Surgery (MIGS)-First Coast Service Options, Inc. 12/30/2019
L38135 MolDX: TruGraf Blood Gene Expression Test -Noridian Healthcare Solutions, LLC 01/05/2020
L38137 MolDX: TruGraf Blood Gene Expression Test -Noridian Healthcare Solutions, LLC 01/05/2020
L38029 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease-Palmetto GBA 01/06/2020
L38166 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease-Wisconsin Physicians Service Insurance Corporation 01/12/2020
L38041 MolDX: Prospera™-Palmetto GBA 02/03/2020
L38043 MolDX: Plasma-Based Genomic Profiling in Solid Tumors-Palmetto GBA 02/03/2020
L38158 MolDX: Next-Generation Sequencing for Solid Tumors-Wisconsin Physicians Service Insurance Corporation 02/09/2020
L38176 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Wisconsin Physicians Service Insurance Corporation 02/09/2020
L38045 MolDX: Next-Generation Sequencing for Solid Tumors-Palmetto GBA 02/10/2020
L38047 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Palmetto GBA 02/10/2020
L38051 MolDX: Pigmented Lesion Assay-Palmetto GBA 02/10/2020
L38067 MolDX: Next-Generation Sequencing for Solid Tumors-CGS Administrators, LLC 02/10/2020
L38070 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-CGS Administrators, LLC 02/10/2020
L38059 MolDX: Prospera-CGS Administrators, LLC 03/10/2020
L38168 MolDX: Plasma-Based Genomic Profiling in Solid Tumors-Wisconsin Physicians Service Insurance Corporation 03/15/2020
L38310 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Noridian Healthcare Solutions, LLC 03/15/2020
L38312 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Noridian Healthcare Solutions, LLC 03/15/2020
L38385 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Novitas Solutions, Inc. 03/15/2020
L38396 Cardiology Non-emergent Outpatient Stress Testing-First Coast Service Options, Inc. 03/15/2020
L38398 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-First Coast Service Options, Inc. 03/15/2020
L38299 Micro-Invasive Glaucoma Surgery (MIGS) -Noridian Healthcare Solutions, LLC 03/23/2020
L38301 Micro-Invasive Glaucoma Surgery (MIGS) -Noridian Healthcare Solutions, LLC 03/23/2020
L38111 MolDX: Pigmented Lesion Assay-CGS Administrators, LLC 03/30/2020
L38262 Salvage High-intensity Focused Ultrasound (HIFU) Treatment in Prostate Cancer (PCa)-National Government Services, Inc. 04/01/2020
L38268 Immune Thrombocytopenia (ITP) Therapy-CGS Administrators, LLC 04/01/2020
L38307 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-CGS Administrators, LLC 04/01/2020
L38367 Fluid Jet System Treatment for LUTS/BPH-National Government Services, Inc. 04/01/2020
L38378 Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)-CGS Administrators, LLC 04/01/2020
L38387 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-National Government Services, Inc. 04/01/2020
L38077 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease-CGS Administrators, LLC 04/06/2020
L38174 MolDX: Prospera™-Wisconsin Physicians Service Insurance Corporation 04/12/2020
L38178 MolDX: Pigmented Lesion Assay-Wisconsin Physicians Service Insurance Corporation 04/12/2020
L38147 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease-Noridian Healthcare Solutions, LLC 05/04/2020
L38149 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease-Noridian Healthcare Solutions, LLC 05/04/2020
L38119 MolDX: Next-Generation Sequencing for Solid Tumors-Noridian Healthcare Solutions, LLC 05/17/2020
L38121 MolDX: Next-Generation Sequencing for Solid Tumors-Noridian Healthcare Solutions, LLC 05/17/2020
L38123 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Noridian Healthcare Solutions, LLC 05/17/2020
L38125 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Noridian Healthcare Solutions, LLC 05/17/2020
L38274 MolDX: Repeat Germline Testing-Palmetto GBA 05/31/2020
L38151 MolDX: Pigmented Lesion Assay-Noridian Healthcare Solutions, LLC 06/07/2020
L38153 MolDX: Pigmented Lesion Assay-Noridian Healthcare Solutions, LLC 06/07/2020
L38288 MolDX: Repeat Germline Testing-CGS Administrators, LLC 06/07/2020
L38238 MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer-Palmetto GBA 06/14/2020
L38429 MolDX: Repeat Germline Testing-Wisconsin Physicians Service Insurance Corporation 06/14/2020
L38443 MolDX: Predictive Classifiers for Early Stage Non-small Cell Lung Cancer-Wisconsin Physicians Service Insurance Corporation 06/14/2020
L38528 Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Wisconsin Physicians Service Insurance Corporation 06/14/2020
L38276 Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea-Palmetto GBA 06/21/2020
L38371 Multimarker Serum Tests Related to Ovarian Cancer Testing-National Government Services, Inc. 07/01/2020
L38495 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor-Novitas Solutions, Inc. 07/12/2020
L38506 Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor-First Coast Service Options, Inc. 07/12/2020
L38294 MolDX: Pharmacogenomics Testing-Palmetto GBA 07/26/2020
L38435 MolDX: Pharmacogenomics Testing-Wisconsin Physicians Service Insurance Corporation 07/26/2020
L38065 MolDX: Plasma-Based Genomic Profiling in Solid Tumors-CGS Administrators, LLC 07/27/2020
L38284 MolDX: Predictive Classifiers for Early Stage Non-small Cell Lung Cancer-CGS Administrators, LLC 07/27/2020
L38351 MolDX: Repeat Germline Testing-Noridian Healthcare Solutions, LLC 08/03/2020
L38353 MolDX: Repeat Germline Testing-Noridian Healthcare Solutions, LLC 08/03/2020
L38394 MolDX: Pharmacogenomics Testing-CGS Administrators, LLC 08/03/2020
L38335 MolDX: Pharmacogenomics Testing-Noridian Healthcare Solutions, LLC 08/17/2020
L38337 MolDX: Pharmacogenomics Testing-Noridian Healthcare Solutions, LLC 08/17/2020
L38327 MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer-Noridian Healthcare Solutions, LLC 08/24/2020
L38329 MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer-Noridian Healthcare Solutions, LLC 08/24/2020
L38551 Transanal Endoscopic Surgery (TES)-Palmetto GBA 10/11/2020
L38617 Implantable Continuous Glucose Monitors (I-CGM)-Novitas Solutions, Inc. 10/11/2020
L38664 Implantable Continuous Glucose Monitors (I-CGM)-First Coast Service Options, Inc. 10/11/2020
L38686 Implantable Continuous Glucose Monitors (I-CGM)-Wisconsin Physicians Service Insurance Corporation 10/11/2020
L38290 MolDX: Minimal Residual Disease Testing for Colorectal Cancer-Palmetto GBA 10/18/2020
L38431 MolDX: Minimal Residual Disease Testing for Colorectal Cancer-Wisconsin Physicians Service Insurance Corporation 10/18/2020
L38305 MolDX: Minimal Residual Disease Testing for Colorectal Cancer-CGS Administrators, LLC 10/19/2020
L38240 MolDX: Blood Product Molecular Antigen Typing-Palmetto GBA 10/25/2020
L38441 MolDX: Blood Product Molecular Antigen Typing-Wisconsin Physicians Service Insurance Corporation 10/25/2020
L38249 MolDX: Blood Product Molecular Antigen Typing-CGS Administrators, LLC 11/01/2020
L38667 Computed Tomography Cerebral Perfusion Analysis (CTP)-National Government Services, Inc. 11/01/2020
L38657 Implantable Continuous Glucose Monitors (I-CGM)-Noridian Healthcare Solutions, LLC 11/02/2020
L38659 Implantable Continuous Glucose Monitors (I-CGM)-Noridian Healthcare Solutions, LLC 11/02/2020
L38662 Implantable Continuous Glucose Monitors (I-CGM)-CGS Administrators, LLC 11/02/2020
L38694 Computed Tomography Cerebral Perfusion Analysis (CTP)-CGS Administrators, LLC 11/02/2020
L38292 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease-Palmetto GBA 11/08/2020
L38433 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease-Wisconsin Physicians Service Insurance Corporation 11/08/2020
L38303 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease-CGS Administrators, LLC 11/09/2020
L38255 MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts-Palmetto GBA 11/15/2020
L38439 MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts-Wisconsin Physicians Service Insurance Corporation 11/15/2020
L38278 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease-Palmetto GBA 11/22/2020
L38623 Implantable Continuous Glucose Monitors (I-CGM)-National Government Services, Inc. 12/01/2020
L38331 MolDX: Blood Product Molecular Antigen Typing-Noridian Healthcare Solutions, LLC 12/06/2020
L38333 MolDX: Blood Product Molecular Antigen Typing-Noridian Healthcare Solutions, LLC 12/06/2020
L38339 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease-Noridian Healthcare Solutions, LLC 12/06/2020
L38341 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease-Noridian Healthcare Solutions, LLC 12/06/2020
L38355 MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts-Noridian Healthcare Solutions, LLC 12/06/2020
L38380 MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts-Noridian Healthcare Solutions, LLC 12/06/2020
L38700 Computed Tomography Cerebral Perfusion Analysis (CTP)-Noridian Healthcare Solutions, LLC 12/13/2020
L38709 Computed Tomography Cerebral Perfusion Analysis (CTP)-Noridian Healthcare Solutions, LLC 12/13/2020
L38549 Transurethral Waterjet Ablation of the Prostate-Palmetto GBA 12/27/2020
L38682 Transurethral Waterjet Ablation of the Prostate-Wisconsin Physicians Service Insurance Corporation 12/27/2020
L38705 Transurethral Waterjet Ablation of the Prostate-Noridian Healthcare Solutions, LLC 12/27/2020
L38707 Transurethral Waterjet Ablation of the Prostate-Noridian Healthcare Solutions, LLC 12/27/2020
L38712 Transurethral Waterjet Ablation of the Prostate-Novitas Solutions, Inc. 12/27/2020
L38720 Treatment of Chronic Venous Insufficiency of the Lower Extremities-First Coast Service Options, Inc. 12/27/2020
L38726 Transurethral Waterjet Ablation of the Prostate-First Coast Service Options, Inc. 12/27/2020
L38272 MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts-CGS Administrators, LLC 12/28/2020


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