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LCD	Title	Revision Effective Date
L38367	Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)-National Government Services, Inc.	09/01/2020
L38378	Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)-CGS Administrators, LLC	09/01/2020
L34976	Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)-First Coast Service Options, Inc.	07/12/2020
L35130	Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)-Novitas Solutions, Inc.	07/12/2020
L35000	Molecular Pathology Procedures-National Government Services, Inc.	07/01/2020
L36113	MolDX: MGMT Promoter Methylation Analysis-CGS Administrators, LLC	06/04/2020
L37134	MolDX: BDX-XL2-CGS Administrators, LLC	06/04/2020
L37142	MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-CGS Administrators, LLC	06/04/2020
L33794	External Infusion Pumps-Noridian Administrative Services	05/31/2020
L36408	Allergy Immunotherapy-Wisconsin Physicians Service Insurance Corporation	05/28/2020
L37644	YAG Capsulotomy-Palmetto GBA	05/28/2020
L37863	Voretigene Neparvovec-rzyl (Luxturna®)-Palmetto GBA	05/28/2020
L38168	MolDX: Plasma-Based Genomic Profiling in Solid Tumors-Wisconsin Physicians Service Insurance Corporation	05/28/2020
L35428	Thrombolytic Agents-Novitas Solutions, Inc.	05/24/2020
L33370	Nebulizers-Noridian Administrative Services	05/17/2020
L34645	Drug Testing-Wisconsin Physicians Service Insurance Corporation	05/10/2020
L34528	Blepharoplasty, Blepharoptosis and Brow Lift-Wisconsin Physicians Service Insurance Corporation	04/30/2020
L34977	Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters-Novitas Solutions, Inc.	04/30/2020
L37921	MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-Wisconsin Physicians Service Insurance Corporation	04/30/2020
L38158	MolDX: Next-Generation Sequencing for Solid Tumors-Wisconsin Physicians Service Insurance Corporation	04/30/2020
L38176	MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Wisconsin Physicians Service Insurance Corporation	04/30/2020
L33410	Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-First Coast Service Options, Inc.	04/19/2020
L35076	Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-National Government Services, Inc.	04/01/2020
L35080	Select Minimally Invasive GERD Procedures-National Government Services, Inc.	04/01/2020
L38307	Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-CGS Administrators, LLC	04/01/2020
L38387	Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-National Government Services, Inc.	04/01/2020
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
L35094	Services That Are Not Reasonable and Necessary-Novitas Solutions, Inc.	03/15/2020
L38310	Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea-Noridian Healthcare Solutions, LLC	03/15/2020
L37870	MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-Palmetto GBA	03/05/2020
L37903	MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-CGS Administrators, LLC	03/05/2020
L38043	MolDX: Plasma-Based Genomic Profiling in Solid Tumors-Palmetto GBA	03/05/2020
L38045	MolDX: Next-Generation Sequencing for Solid Tumors-Palmetto GBA	03/05/2020
L38047	MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-Palmetto GBA	03/05/2020
L38067	MolDX: Next-Generation Sequencing for Solid Tumors-CGS Administrators, LLC	03/05/2020
L38070	MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies-CGS Administrators, LLC	03/05/2020
L33747	Pegfilgrastim-First Coast Service Options, Inc.	02/26/2020
L34551	One Day Stays for Chest Pain-Palmetto GBA	02/20/2020
L34106	Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-Noridian Healthcare Solutions, LLC	02/19/2020
L34228	Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-Noridian Healthcare Solutions, LLC	02/19/2020
L35111	Hemophilia Factor Products-Novitas Solutions, Inc.	02/13/2020
L38026	Corneal Hysteresis-Palmetto GBA	02/13/2020
L37531	Micro-Invasive Glaucoma Surgery (MIGS) -Palmetto GBA	02/10/2020
L37761	Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor-Palmetto GBA	02/10/2020
L34633	Erythropoiesis Stimulating Agents (ESAs)-Wisconsin Physicians Service Insurance Corporation	02/09/2020
L35490	Category III Codes-Wisconsin Physicians Service Insurance Corporation	02/09/2020
L37228	Wound Care-Wisconsin Physicians Service Insurance Corporation	02/09/2020
L34074	Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC	02/01/2020
L34314	Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC	02/01/2020
L34635	Botulinum Toxin Type A & Type B-Wisconsin Physicians Service Insurance Corporation	01/30/2020
L35125	Wound Care-Novitas Solutions, Inc.	01/16/2020
L34869	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Palmetto GBA	01/13/2020
L36456	MolDX: BRCA1 and BRCA2 Genetic Testing-CGS Administrators, LLC	01/09/2020
L37834	MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-CGS Administrators, LLC	01/09/2020
L37798	4Kscore Test Algorithm-First Coast Service Options, Inc.	01/06/2020
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
L33312	Wheelchair Seating-Noridian Administrative Services	01/01/2020
L33317	External Breast Prostheses-Noridian Administrative Services	01/01/2020
L33318	Knee Orthoses-Noridian Administrative Services	01/01/2020
L33369	Therapeutic Shoes for Persons with Diabetes-Noridian Administrative Services	01/01/2020
L33399	EEG – Ambulatory Monitoring-National Government Services, Inc.	01/01/2020
L33610	Intravenous Immune Globulin-Noridian Administrative Services	01/01/2020
L33611	Oral Appliances for Obstructive Sleep Apnea-Noridian Administrative Services	01/01/2020
L33612	Suction Pumps-Noridian Administrative Services	01/01/2020
L33631	Outpatient Physical and Occupational Therapy Services-National Government Services, Inc.	01/01/2020
L33641	Orthopedic Footwear-Noridian Administrative Services	01/01/2020
L33642	Pressure Reducing Support Surfaces - Group 2-Noridian Administrative Services	01/01/2020
L33686	Ankle-Foot/Knee-Ankle-Foot Orthosis-Noridian Administrative Services	01/01/2020
L33690	Automatic External Defibrillators-Noridian Administrative Services	01/01/2020
L33692	Pressure Reducing Support Surfaces - Group 3-Noridian Administrative Services	01/01/2020
L33718	Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea-Noridian Administrative Services	01/01/2020
L33733	Canes and Crutches-Noridian Administrative Services	01/01/2020
L33735	Cold Therapy-Noridian Administrative Services	01/01/2020
L33736	Commodes-Noridian Administrative Services	01/01/2020
L33737	Eye Prostheses-Noridian Administrative Services	01/01/2020
L33738	Facial Prostheses-Noridian Administrative Services	01/01/2020
L33739	Speech Generating Devices (SGD)-Noridian Administrative Services	01/01/2020
L33783	Enteral Nutrition-Noridian Administrative Services	01/01/2020
L33784	Heating Pads and Heat Lamps-Noridian Administrative Services	01/01/2020
L33785	High Frequency Chest Wall Oscillation Devices-Noridian Administrative Services	01/01/2020
L33786	Intrapulmonary Percussive Ventilation System-Noridian Administrative Services	01/01/2020
L33787	Lower Limb Prostheses-Noridian Administrative Services	01/01/2020
L33788	Manual Wheelchair Bases-Noridian Administrative Services	01/01/2020
L33789	Power Mobility Devices-Noridian Administrative Services	01/01/2020
L33790	Spinal Orthoses: TLSO and LSO-Noridian Administrative Services	01/01/2020
L33791	Walkers-Noridian Administrative Services	01/01/2020
L33792	Wheelchair Options/Accessories-Noridian Administrative Services	01/01/2020
L33793	Refractive Lenses-Noridian Administrative Services	01/01/2020
L33795	Mechanical In-exsufflation Devices-Noridian Administrative Services	01/01/2020
L33796	Osteogenesis Stimulators-Noridian Administrative Services	01/01/2020
L33798	Parenteral Nutrition-Noridian Administrative Services	01/01/2020
L33799	Patient Lifts-Noridian Administrative Services	01/01/2020
L33800	Respiratory Assist Devices-Noridian Administrative Services	01/01/2020
L33801	Seat Lift Mechanisms-Noridian Administrative Services	01/01/2020
L33802	Transcutaneous Electrical Nerve Stimulators (TENS)-Noridian Administrative Services	01/01/2020
L33820	Hospital Beds And Accessories-Noridian Administrative Services	01/01/2020
L33821	Negative Pressure Wound Therapy Pumps-Noridian Administrative Services	01/01/2020
L33822	Glucose Monitors-Noridian Administrative Services	01/01/2020
L33823	Cervical Traction Devices-Noridian Administrative Services	01/01/2020
L33824	Immunosuppressive Drugs-Noridian Administrative Services	01/01/2020
L33825	Infrared Heating Pad Systems-Noridian Administrative Services	01/01/2020
L33826	Oral Anticancer Drugs-Noridian Administrative Services	01/01/2020
L33827	Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)-Noridian Administrative Services	01/01/2020
L33828	Ostomy Supplies-Noridian Administrative Services	01/01/2020
L33829	Pneumatic Compression Devices-Noridian Administrative Services	01/01/2020
L33830	Pressure Reducing Support Surfaces - Group 1-Noridian Administrative Services	01/01/2020
L33831	Surgical Dressings-Noridian Administrative Services	01/01/2020
L33832	Tracheostomy Care Supplies-Noridian Administrative Services	01/01/2020
L34821	Transcutaneous Electrical Joint Stimulation Devices (TEJSD)-Noridian Administrative Services	01/01/2020
L34823	Tumor Treatment Field Therapy (TTFT)-Noridian Administrative Services	01/01/2020
L34824	Vacuum Erection Devices (VED)-Noridian Administrative Services	01/01/2020
L35021	Hyperbaric Oxygen (HBO) Therapy-Novitas Solutions, Inc.	01/01/2020
L35162	Ambulance Services (Ground Ambulance)-Novitas Solutions, Inc.	01/01/2020
L36267	Bowel Management Devices-Noridian Administrative Services	01/01/2020
L36807	MolDX: Molecular Diagnostic Tests (MDT)-Wisconsin Physicians Service Insurance Corporation	01/01/2020
L37066	Lab: Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC	01/01/2020
L37068	Lab: Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC	01/01/2020
L37210	MolDX: Decision Dx-UM (Uveal Melanoma)-Wisconsin Physicians Service Insurance Corporation	01/01/2020
L37822	MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test -Noridian Healthcare Solutions, LLC	01/01/2020
L37824	MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test -Noridian Healthcare Solutions, LLC	01/01/2020
L37578	Micro-Invasive Glaucoma Surgery (MIGS)-CGS Administrators, LLC	12/30/2019
L37792	4Kscore Test Algorithm-Novitas Solutions, Inc.	12/30/2019
L38229	Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) -Novitas Solutions, Inc.	12/30/2019
L33636	Routine Foot Care and Debridement of Nails-National Government Services, Inc.	12/26/2019
L33954	Cataract Extraction-CGS Administrators, LLC	12/26/2019
L34370	Category III CPT® Codes-CGS Administrators, LLC	12/26/2019
L34807	Lumbar Epidural Steroid Injections (ESI)-CGS Administrators, LLC	12/26/2019
L34832	Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-CGS Administrators, LLC	12/26/2019
L35751	Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies-Wisconsin Physicians Service Insurance Corporation	12/26/2019
L35753	Non-Invasive Cerebrovascular Studies-Wisconsin Physicians Service Insurance Corporation	12/26/2019
L35755	Non-Invasive Abdominal / Visceral Vascular Studies-Wisconsin Physicians Service Insurance Corporation	12/26/2019
L36460	Bone Mass Measurement-CGS Administrators, LLC	12/26/2019
L36469	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-CGS Administrators, LLC	12/26/2019
L36485	MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-CGS Administrators, LLC	12/26/2019
L36494	Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint-CGS Administrators, LLC	12/26/2019
L36793	MolDX: Genetic Testing for Lynch Syndrome-Wisconsin Physicians Service Insurance Corporation	12/26/2019
L33580	Speech-Language Pathology-National Government Services, Inc.	12/19/2019
L36021	MolDX: Molecular Diagnostic Tests (MDT)-CGS Administrators, LLC	12/19/2019
L36117	MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-CGS Administrators, LLC	12/19/2019
L33937	Proton Beam Radiotherapy-First Coast Service Options, Inc.	12/16/2019
L38160	MolDX: TruGraf® Blood Gene Expression Test-Wisconsin Physicians Service Insurance Corporation	12/16/2019
L35025	MolDX: Molecular Diagnostic Tests (MDT)-Palmetto GBA	12/12/2019
L34063	RAST Type Tests-CGS Administrators, LLC	12/05/2019
L34084	Transcatheter Infusion Therapy-CGS Administrators, LLC	12/05/2019
L34181	Ophthalmic Biometry for Intraocular Lens Power Calculation-CGS Administrators, LLC	12/05/2019
L34399	Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)-CGS Administrators, LLC	12/05/2019
L35024	MolDX: Genetic Testing for Lynch Syndrome-Palmetto GBA	12/05/2019
L35349	MolDX: Genetic Testing for Lynch Syndrome-CGS Administrators, LLC	12/05/2019
L35936	Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-National Government Services, Inc.	12/05/2019
L37643	Routine Foot Care-Palmetto GBA	12/05/2019
L36082	MolDX: BRCA1 and BRCA2 Genetic Testing-Palmetto GBA	12/04/2019
L36161	MolDX: BRCA1 and BRCA2 Genetic Testing-Noridian Healthcare Solutions, LLC	12/04/2019
L36163	MolDX: BRCA1 and BRCA2 Genetic Testing-Noridian Healthcare Solutions, LLC	12/04/2019
L33569	Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)-National Government Services, Inc.	12/01/2019
L34010	Treatment of Varicose Veins of the Lower Extremities-Noridian Healthcare Solutions, LLC	12/01/2019
L34040	Polysomnography and Other Sleep Studies-Noridian Healthcare Solutions, LLC	12/01/2019
L34051	Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC	12/01/2019
L34066	MolDX: Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC	12/01/2019
L34151	Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-Noridian Healthcare Solutions, LLC	12/01/2019
L34163	Total Hip Arthroplasty-Noridian Healthcare Solutions, LLC	12/01/2019
L34209	Treatment of Varicose Veins of the Lower Extremities-Noridian Healthcare Solutions, LLC	12/01/2019
L34211	Trigger Point Injections-Noridian Healthcare Solutions, LLC	12/01/2019
L34215	Lab: Flow Cytometry-Noridian Healthcare Solutions, LLC	12/01/2019
L34223	Stereotactic Radiosurgery-Noridian Healthcare Solutions, LLC	12/01/2019
L34224	Stereotactic Body Radiation Therapy-Noridian Healthcare Solutions, LLC	12/01/2019
L34328	Peripheral Nerve Stimulation-Noridian Healthcare Solutions, LLC	12/01/2019
L34993	Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC	12/01/2019
L34995	Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC	12/01/2019
L35008	Non-Covered Services-Noridian Healthcare Solutions, LLC	12/01/2019
L35136	Spinal Cord Stimulators for Chronic Pain-Noridian Healthcare Solutions, LLC	12/01/2019
L35456	Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC	12/01/2019
L35457	Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC	12/01/2019
L35702	Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC	12/01/2019
L35704	Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC	12/01/2019
L35710	MolDX: Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC	12/01/2019
L36094	Lab: Flow Cytometry-Noridian Healthcare Solutions, LLC	12/01/2019
L36204	Spinal Cord Stimulators for Chronic Pain-Noridian Healthcare Solutions, LLC	12/01/2019
L36219	Non-Covered Services-Noridian Healthcare Solutions, LLC	12/01/2019
L36335	MolDX: NRAS Genetic Testing-Noridian Healthcare Solutions, LLC	12/01/2019
L36339	MolDX: NRAS Genetic Testing-Noridian Healthcare Solutions, LLC	12/01/2019
L36343	MolDX: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC	12/01/2019
L36345	MolDX: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC	12/01/2019
L36348	MolDX: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC	12/01/2019
L36350	MolDX: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC	12/01/2019
L36351	Lab: Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC	12/01/2019
L36353	Lab: Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC	12/01/2019
L36524	Nerve Conduction Studies and Electromyography-Noridian Healthcare Solutions, LLC	12/01/2019
L36526	Nerve Conduction Studies and Electromyography-Noridian Healthcare Solutions, LLC	12/01/2019
L36573	Total Hip Arthroplasty-Noridian Healthcare Solutions, LLC	12/01/2019
L36575	Total Knee Arthroplasty-Noridian Healthcare Solutions, LLC	12/01/2019
L36577	Total Knee Arthroplasty-Noridian Healthcare Solutions, LLC	12/01/2019
L36692	Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC	12/01/2019
L36704	MolDX: ProMark Risk Score-Noridian Healthcare Solutions, LLC	12/01/2019
L36706	MolDX: ProMark Risk Score-Noridian Healthcare Solutions, LLC	12/01/2019
L36859	Trigger Point Injections-Noridian Healthcare Solutions, LLC	12/01/2019
L36861	Polysomnography and Other Sleep Studies-Noridian Healthcare Solutions, LLC	12/01/2019
L36886	MolDX: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC	12/01/2019
L36891	MolDX: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC	12/01/2019
L36941	MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Noridian Healthcare Solutions, LLC	12/01/2019
L36947	MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Noridian Healthcare Solutions, LLC	12/01/2019
L37070	MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC	12/01/2019
L37072	MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC	12/01/2019
L37080	MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC	12/01/2019
L37082	MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC	12/01/2019
L37086	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Noridian Healthcare Solutions, LLC	12/01/2019
L37088	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Noridian Healthcare Solutions, LLC	12/01/2019
L37244	Micro-Invasive Glaucoma Surgery (MIGS) -National Government Services, Inc.	12/01/2019
L37299	MolDX: Prometheus IBD sgi Diagnostic Policy-Noridian Healthcare Solutions, LLC	12/01/2019
L37313	MolDX: Prometheus IBD sgi Diagnostic Policy-Noridian Healthcare Solutions, LLC	12/01/2019
L37360	Peripheral Nerve Stimulation-Noridian Healthcare Solutions, LLC	12/01/2019
L37628	In Vitro Chemosensitivity & Chemoresistance Assays-Noridian Healthcare Solutions, LLC	12/01/2019
L37630	In Vitro Chemosensitivity & Chemoresistance Assays-Noridian Healthcare Solutions, LLC	12/01/2019
L37733	Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis-National Government Services, Inc.	12/01/2019
L37744	MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-Noridian Healthcare Solutions, LLC	12/01/2019
L37746	MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-Noridian Healthcare Solutions, LLC	12/01/2019
L37808	Water Vapor Thermal Therapy for LUTS/BPH -National Government Services, Inc.	12/01/2019
L33629	Non-covered Services-National Government Services, Inc.	11/28/2019
L33632	Psychiatry and Psychology Services-National Government Services, Inc.	11/28/2019
L33751	Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-First Coast Service Options, Inc.	11/28/2019
L33814	Destruction of Paravertebral Facet Joint Nerve(s)-First Coast Service Options, Inc.	11/28/2019
L33833	Surgical Treatment of Nails-First Coast Service Options, Inc.	11/28/2019
L33922	Nail Debridement-First Coast Service Options, Inc.	11/28/2019
L33924	Omalizumab-First Coast Service Options, Inc.	11/28/2019
L33943	B-type Natriuretic Peptide (BNP) Testing-CGS Administrators, LLC	11/28/2019
L33949	Botulinum Toxins-CGS Administrators, LLC	11/28/2019
L33950	Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography-CGS Administrators, LLC	11/28/2019
L33967	Vitamin B12 Injections-First Coast Service Options, Inc.	11/28/2019
L33975	Psychiatric Inpatient Hospitalization-First Coast Service Options, Inc.	11/28/2019
L33996	Vitamin D Assay Testing-CGS Administrators, LLC	11/28/2019
L34007	Intravenous Immune Globulin-First Coast Service Options, Inc.	11/28/2019
L34045	Non-Invasive Vascular Studies-CGS Administrators, LLC	11/28/2019
L34246	Routine Foot Care and Debridement of Nails-CGS Administrators, LLC	11/28/2019
L34372	Magnetic Resonance Angiography (MRA)-First Coast Service Options, Inc.	11/28/2019
L34522	Transcranial Magnetic Stimulation for Major Depressive Disorder-First Coast Service Options, Inc.	11/28/2019
L34539	Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians-CGS Administrators, LLC	11/28/2019
L35026	Rituximab-Palmetto GBA	11/28/2019
L35121	Coronary Computed Tomography Angiography (CCTA)-Wisconsin Physicians Service Insurance Corporation	11/28/2019
L35442	MolDX: NRAS Genetic Testing-CGS Administrators, LLC	11/28/2019
L35443	MolDX: GeneSight ® Assay for Refractory Depression-CGS Administrators, LLC	11/28/2019
L35698	CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-First Coast Service Options, Inc.	11/28/2019
L36035	Spinal Cord Stimulation for Chronic Pain-First Coast Service Options, Inc.	11/28/2019
L36234	Special Histochemical Stains & Immunohistochemical Stains -First Coast Service Options, Inc.	11/28/2019
L36398	MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Wisconsin Physicians Service Insurance Corporation	11/28/2019
L36504	Hyperbaric Oxygen (HBO) Therapy -First Coast Service Options, Inc.	11/28/2019
L36675	MolDX- CDD: ProMark Risk Score-CGS Administrators, LLC	11/28/2019
L36908	MolDX: Percepta® Bronchial Genomic Classifier-CGS Administrators, LLC	11/28/2019
L36910	MolDX: APC and MUTYH Gene Testing -CGS Administrators, LLC	11/28/2019
L36951	MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) -CGS Administrators, LLC	11/28/2019
L37166	Wound Care-First Coast Service Options, Inc.	11/28/2019
L37205	Chemotherapy Drugs and their Adjuncts-Wisconsin Physicians Service Insurance Corporation	11/28/2019
L37216	MolDX: BDX-XL2-Wisconsin Physicians Service Insurance Corporation	11/28/2019
L37348	MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-CGS Administrators, LLC	11/28/2019
L37364	Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -CGS Administrators, LLC	11/28/2019
L37398	Electroretinography (ERG)-First Coast Service Options, Inc.	11/28/2019
L37561	Cystatin C Measurement-First Coast Service Options, Inc.	11/28/2019
L37598	MolDX: Cystatin C Measurement-CGS Administrators, LLC	11/28/2019
L37667	MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Wisconsin Physicians Service Insurance Corporation	11/28/2019
L37697	Emergency and Non-Emergency Ground Ambulance Services-First Coast Service Options, Inc.	11/28/2019
L37764	MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Wisconsin Physicians Service Insurance Corporation	11/28/2019
L33762	Treatment of varicose veins of the lower extremity-First Coast Service Options, Inc.	11/27/2019
L33777	Noncovered Services-First Coast Service Options, Inc.	11/27/2019
L33910	Independent Diagnostic Testing Facility (IDTF)-First Coast Service Options, Inc.	11/25/2019
L33575	Varicose Veins of the Lower Extremity, Treatment of-National Government Services, Inc.	11/21/2019
L33616	Osteopathic Manipulative Treatment-National Government Services, Inc.	11/21/2019
L34578	Surface Electrical Stimulation in the Treatment of Dysphagia-Palmetto GBA	11/21/2019
L34892	Facet Joint Interventions for Pain Management-Novitas Solutions, Inc.	11/21/2019
L35010	Trigger Point Injections-Novitas Solutions, Inc.	11/21/2019
L35035	Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography-Novitas Solutions, Inc.	11/21/2019
L35068	Evaluation and Management Services Provided in a Nursing Facility-Novitas Solutions, Inc.	11/21/2019
L35089	Wireless Capsule Endoscopy-Novitas Solutions, Inc.	11/21/2019
L35098	Nerve Conduction Studies and Electromyography-National Government Services, Inc.	11/21/2019
L35724	Lab: Controlled Substance Monitoring and Drugs of Abuse Testing-Palmetto GBA	11/21/2019
L35974	MolDX: MGMT Promoter Methylation Analysis-Palmetto GBA	11/21/2019
L36029	Controlled Substance Monitoring and Drugs of Abuse Testing-CGS Administrators, LLC	11/21/2019
L36125	MolDX: Breast Cancer Assay: Prosigna -Palmetto GBA	11/21/2019
L36850	Peripheral Nerve Blocks-National Government Services, Inc.	11/21/2019
L36920	Epidural Injections for Pain Management -Novitas Solutions, Inc.	11/21/2019
L37371	Electroretinography (ERG)-Novitas Solutions, Inc.	11/21/2019
L37612	MolDX: Corus® CAD Assay-Palmetto GBA	11/21/2019
L37682	Nusinersen (Spinraza) -Novitas Solutions, Inc.	11/21/2019
L37701	MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-Palmetto GBA	11/21/2019
L37836	MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-CGS Administrators, LLC	11/21/2019
L37893	Endovenous Stenting-Novitas Solutions, Inc.	11/21/2019
L33261	Allergy Testing-First Coast Service Options, Inc.	11/19/2019
L33393	Hospice - Determining Terminal Status-National Government Services, Inc.	11/14/2019
L33449	Swallowing Studies for Dysphagia-Palmetto GBA	11/14/2019
L33624	Psychiatric Inpatient Hospitalization-National Government Services, Inc.	11/14/2019
L33626	Psychiatric Partial Hospitalization Programs-National Government Services, Inc.	11/14/2019
L34049	Outpatient Physical and Occupational Therapy Services-CGS Administrators, LLC	11/14/2019
L34427	Outpatient Occupational Therapy-Palmetto GBA	11/14/2019
L34428	Outpatient Physical Therapy-Palmetto GBA	11/14/2019
L34559	Hospice - Renal Care-Palmetto GBA	11/14/2019
L34822	Luteinizing Hormone-Releasing Hormone (LHRH) Analogs-Novitas Solutions, Inc.	11/14/2019
L34864	Loss-of-Heterozygosity Based Topographic Genotyping with PathfinderTG ®-Novitas Solutions, Inc.	11/14/2019
L34924	Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities-Novitas Solutions, Inc.	11/14/2019
L34961	Mohs Micrographic Surgery (MMS)-Novitas Solutions, Inc.	11/14/2019
L34996	Neuromuscular Junction Testing-Novitas Solutions, Inc.	11/14/2019
L35003	Intraoperative Neurophysiological Testing-Novitas Solutions, Inc.	11/14/2019
L35011	Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Novitas Solutions, Inc.	11/14/2019
L35028	Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency-National Government Services, Inc.	11/14/2019
L35032	Flow Cytometry-Novitas Solutions, Inc.	11/14/2019
L35036	Therapy and Rehabilitation Services (PT, OT)-Novitas Solutions, Inc.	11/14/2019
L35093	Intravenous Immune Globulin (IVIG)-Novitas Solutions, Inc.	11/14/2019
L35095	Lacrimal Punctum Plugs-Novitas Solutions, Inc.	11/14/2019
L35112	Implantable Infusion Pump-Novitas Solutions, Inc.	11/14/2019
L35391	Multiple Imaging in Oncology-Novitas Solutions, Inc.	11/14/2019
L35395	Autonomic Function Tests-Novitas Solutions, Inc.	11/14/2019
L35396	Biomarkers for Oncology-Novitas Solutions, Inc.	11/14/2019
L35433	Barium Swallow Studies, Modified-Novitas Solutions, Inc.	11/14/2019
L36007	Lower Extremity Major Joint Replacement (Hip and Knee)-Novitas Solutions, Inc.	11/14/2019
L36139	MolDX: Biomarkers in Cardiovascular Risk Assessment-CGS Administrators, LLC	11/14/2019
L36206	MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay-CGS Administrators, LLC	11/14/2019
L36240	Allergen Immunotherapy -Novitas Solutions, Inc.	11/14/2019
L36419	Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure -Novitas Solutions, Inc.	11/14/2019
L36434	Microvascular Therapy-Novitas Solutions, Inc.	11/14/2019
L36634	In Vitro Chemosensitivity & Chemoresistance Assays -Novitas Solutions, Inc.	11/14/2019
L36656	MolDX: Decipher® Prostate Cancer Classifier Assay-CGS Administrators, LLC	11/14/2019
L36711	Intensity Modulated Radiation Therapy (IMRT)-Novitas Solutions, Inc.	11/14/2019
L37352	MolDX: Prometheus IBD sgi Diagnostic Policy-CGS Administrators, LLC	11/14/2019
L37354	MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-CGS Administrators, LLC	11/14/2019
L37356	MolDX: EndoPredict Breast Cancer Gene Expression Test-CGS Administrators, LLC	11/14/2019
L37366	Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-CGS Administrators, LLC	11/14/2019
L37535	Vitamin D Assay Testing-National Government Services, Inc.	11/14/2019
L37785	MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-Palmetto GBA	11/14/2019
L32553	Allergy Immunotherapy-CGS Administrators, LLC	11/07/2019
L33394	Drugs and Biologicals, Coverage of, for Label and Off-Label Uses-National Government Services, Inc.	11/07/2019
L33573	B-type Natriuretic Peptide (BNP) Testing-National Government Services, Inc.	11/07/2019
L33591	RAST Type Tests-National Government Services, Inc.	11/07/2019
L33614	Debridement Services-National Government Services, Inc.	11/07/2019
L33623	Percutaneous Coronary Intervention-National Government Services, Inc.	11/07/2019
L33944	Blepharoplasty-CGS Administrators, LLC	11/07/2019
L33946	Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy-CGS Administrators, LLC	11/07/2019
L33959	Cardiac Catheterization and Coronary Angiography-CGS Administrators, LLC	11/07/2019
L34196	Psychiatric Partial Hospitalization Programs-CGS Administrators, LLC	11/07/2019
L34353	Outpatient Psychiatry and Psychology Services-CGS Administrators, LLC	11/07/2019
L34563	Home Health Speech-Language Pathology-Palmetto GBA	11/07/2019
L34577	Retroperitoneal Ultrasound-Palmetto GBA	11/07/2019
L34834	Blood Glucose Monitoring in a Skilled Nursing Facility (SNF)-Novitas Solutions, Inc.	11/07/2019
L34856	C-Reactive Protein High Sensitivity Testing (hsCRP)-Novitas Solutions, Inc.	11/07/2019
L34862	Co-Management of Surgical Procedures-Novitas Solutions, Inc.	11/07/2019
L35001	Reduction Mammaplasty-National Government Services, Inc.	11/07/2019
L35062	Biomarkers Overview-Novitas Solutions, Inc.	11/07/2019
L35073	MolDX: NRAS Genetic Testing-Palmetto GBA	11/07/2019
L35074	Heavy Metal Testing-National Government Services, Inc.	11/07/2019
L35075	Proton Beam Therapy-National Government Services, Inc.	11/07/2019
L35090	Cosmetic and Reconstructive Surgery-Novitas Solutions, Inc.	11/07/2019
L35091	Cataract Extraction (including Complex Cataract Surgery)-Novitas Solutions, Inc.	11/07/2019
L35092	Diagnostic Abdominal Aortography and Renal Angiography-Novitas Solutions, Inc.	11/07/2019
L35099	Frequency of Laboratory Tests-Novitas Solutions, Inc.	11/07/2019
L35424	Chiropractic Services-Novitas Solutions, Inc.	11/07/2019
L35868	MolDX: Decipher® Prostate Cancer Classifier Assay-Palmetto GBA	11/07/2019
L36002	MolDX: Prolaris™ Prostate Cancer Genomic Assay-CGS Administrators, LLC	11/07/2019
L36006	MolDX: ConfirmMDx Epigenetic Molecular Assay-CGS Administrators, LLC	11/07/2019
L36011	MolDX: Molecular RBC Phenotyping-CGS Administrators, LLC	11/07/2019
L36044	MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Palmetto GBA	11/07/2019
L36048	MolDX: HLA-B*15:02 Genetic Testing-CGS Administrators, LLC	11/07/2019
L36129	MolDX: Biomarkers in Cardiovascular Risk Assessment-Palmetto GBA	11/07/2019
L36665	MolDX: ProMark Risk Score-Palmetto GBA	11/07/2019
L36713	Corus® CAD Test-Novitas Solutions, Inc.	11/07/2019
L36715	BRCA1 and BRCA2 Genetic Testing-Novitas Solutions, Inc.	11/07/2019
L36973	MolDX: Circulating Tumor Cell Marker Assays-CGS Administrators, LLC	11/07/2019
L37022	Lab: Coenzyme Q10 (CoQ10)-Palmetto GBA	11/07/2019
L37260	MolDX: Prometheus IBD sgi Diagnostic Policy-Palmetto GBA	11/07/2019
L37264	MolDX: EndoPredict Breast Cancer Gene Expression Test-Palmetto GBA	11/07/2019
L37581	MolDX: Cystatin C Measurement-Palmetto GBA	11/07/2019
L37608	MolDX: MDS FISH-CGS Administrators, LLC	11/07/2019
L37905	MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-CGS Administrators, LLC	11/07/2019
L37713	MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Palmetto GBA	11/02/2019
L34526	Surgical Treatment of Obstructive Sleep Apnea (OSA)-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34536	Treatment of Varicose Veins of the Lower Extremities-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34588	Trigger Points, Local Injections-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34596	Immunizations-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34614	Colonoscopy and Sigmoidoscopy-Diagnostic-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34623	Intraoperative Neurophysiological Testing-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34624	Somatosensory Testing-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34636	Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34641	Transcranial Magnetic Stimulation (TMS)-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34648	Bisphosphonate Drug Therapy-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34659	Endoscopic Treatment of GERD-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34760	Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L34771	Immune Globulins-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L35124	Autonomic Function Testing-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L35160	MolDX: Molecular Diagnostic Tests (MDT)-Noridian Healthcare Solutions, LLC	11/01/2019
L35222	Nerve Blocks for Peripheral Neuropathy-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L35486	Pelvic Floor Dysfunction: Anorectal Manometry and EMG-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L35761	Non-Invasive Peripheral Arterial Vascular Studies-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L35996	Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L35998	Non-Coronary Vascular Stents-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36000	Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36145	MolDX: HLA-B*15:02 Genetic Testing-Noridian Healthcare Solutions, LLC	11/01/2019
L36149	MolDX: HLA-B*15:02 Genetic Testing-Noridian Healthcare Solutions, LLC	11/01/2019
L36155	MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Noridian Healthcare Solutions, LLC	11/01/2019
L36159	MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Noridian Healthcare Solutions, LLC	11/01/2019
L36167	MolDX: Molecular RBC Phenotyping-Noridian Healthcare Solutions, LLC	11/01/2019
L36171	MolDX: Molecular RBC Phenotyping-Noridian Healthcare Solutions, LLC	11/01/2019
L36180	MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Noridian Healthcare Solutions, LLC	11/01/2019
L36186	MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Noridian Healthcare Solutions, LLC	11/01/2019
L36188	MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC	11/01/2019
L36192	MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC	11/01/2019
L36256	MolDX: Molecular Diagnostic Tests (MDT)-Noridian Healthcare Solutions, LLC	11/01/2019
L36310	MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Noridian Healthcare Solutions, LLC	11/01/2019
L36312	MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Noridian Healthcare Solutions, LLC	11/01/2019
L36323	MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC	11/01/2019
L36325	MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC	11/01/2019
L36327	MolDX: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC	11/01/2019
L36329	MolDX: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC	11/01/2019
L36364	MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Noridian Healthcare Solutions, LLC	11/01/2019
L36368	MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Noridian Healthcare Solutions, LLC	11/01/2019
L36370	MolDX: Genetic Testing for Lynch Syndrome-Noridian Healthcare Solutions, LLC	11/01/2019
L36374	MolDX: Genetic Testing for Lynch Syndrome-Noridian Healthcare Solutions, LLC	11/01/2019
L36380	MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC	11/01/2019
L36386	MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC	11/01/2019
L36400	MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36521	Lumbar Epidural Injections-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36523	MolDX: Biomarkers in Cardiovascular Risk Assessment-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36538	Treatment of Males with Low Testosterone-Noridian Healthcare Solutions, LLC	11/01/2019
L36544	MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Noridian Healthcare Solutions, LLC	11/01/2019
L36551	MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Noridian Healthcare Solutions, LLC	11/01/2019
L36569	Treatment of Males with Low Testosterone-Noridian Healthcare Solutions, LLC	11/01/2019
L36787	MolDX: Prolaris™ Prostate Cancer Genomic Assay -Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36789	MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36791	MolDX: Decipher® Prostate Cancer Classifier Assay -Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36795	MolDX: Molecular RBC Phenotyping-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36797	MolDX: NRAS Genetic Testing-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36799	MolDX: GeneSight® Assay for Refractory Depression-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36801	MolDX: HLA-B*15:02 Genetic Testing-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36805	Lab: Special Histochemical Stains and Immunohistochemical Stains-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36811	MolDX: Breast Cancer Assay: Prosigna-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36813	MolDX: BRCA1 and BRCA2 Genetic Testing-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36815	MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36839	Polysomnography and Other Sleep Studies-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L36846	Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC	11/01/2019
L36857	Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC	11/01/2019
L36882	MolDX: APC and MUTYH Gene Testing -Noridian Healthcare Solutions, LLC	11/01/2019
L36884	MolDX: APC and MUTYH Gene Testing -Noridian Healthcare Solutions, LLC	11/01/2019
L37001	MolDX: MGMT Promoter Methylation Analysis-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37003	MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37005	MolDX: ConfirmMDx Epigenetic Molecular Assay-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37011	MolDX: ProMark Risk Score-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37013	MolDX: 4Kscore Assay-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37015	Visual Electrophysiology Testing-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37054	MolDX: BDX-XL2-Noridian Healthcare Solutions, LLC	11/01/2019
L37062	MolDX: BDX-XL2-Noridian Healthcare Solutions, LLC	11/01/2019
L37120	MolDX: 4Kscore Assay-Noridian Healthcare Solutions, LLC	11/01/2019
L37122	MolDX: 4Kscore Assay-Noridian Healthcare Solutions, LLC	11/01/2019
L37195	MolDX: Percepta® Bronchial Genomic Classifier-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37199	MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37224	MolDX: APC and MUTYH Gene Testing-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37226	MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37295	MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC	11/01/2019
L37303	MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Noridian Healthcare Solutions, LLC	11/01/2019
L37305	MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Noridian Healthcare Solutions, LLC	11/01/2019
L37311	MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC	11/01/2019
L37321	MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Noridian Healthcare Solutions, LLC	11/01/2019
L37358	MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Noridian Healthcare Solutions, LLC	11/01/2019
L37537	Frequency of Hemodialysis-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37539	MolDX: Prometheus IBD sgi Diagnostic Policy-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37547	Chest X-Ray Policy-Noridian Healthcare Solutions, LLC	11/01/2019
L37549	Chest X-Ray Policy-Noridian Healthcare Solutions, LLC	11/01/2019
L37616	MolDX: Cystatin C Measurement-Noridian Healthcare Solutions, LLC	11/01/2019
L37618	MolDX: Cystatin C Measurement-Noridian Healthcare Solutions, LLC	11/01/2019
L37620	MolDX: MDS FISH-Noridian Healthcare Solutions, LLC	11/01/2019
L37622	MolDX: MDS FISH-Noridian Healthcare Solutions, LLC	11/01/2019
L37649	MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-Noridian Healthcare Solutions, LLC	11/01/2019
L37651	MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-Noridian Healthcare Solutions, LLC	11/01/2019
L37663	MolDX: EndoPredict® Breast Cancer Gene Expression Test-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37665	MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37671	MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) -Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37673	MolDX: Corus® CAD Assay-Noridian Healthcare Solutions, LLC	11/01/2019
L37675	MolDX: Corus® CAD Assay-Noridian Healthcare Solutions, LLC	11/01/2019
L37729	Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor-Noridian Healthcare Solutions, LLC	11/01/2019
L37738	Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor-Noridian Healthcare Solutions, LLC	11/01/2019
L37748	MolDX: DecisionDx-Melanoma -Noridian Healthcare Solutions, LLC	11/01/2019
L37750	MolDX: DecisionDx-Melanoma -Noridian Healthcare Solutions, LLC	11/01/2019
L37766	Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37768	MolDX: CYSTATIN C Measurement-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37770	MolDX: CORUS® CAD ASSAY-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37772	MolDX: MDS FISH-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37818	MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-Noridian Healthcare Solutions, LLC	11/01/2019
L37820	MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-Noridian Healthcare Solutions, LLC	11/01/2019
L37879	MolDX: myPath Melanoma Assay -Noridian Healthcare Solutions, LLC	11/01/2019
L37881	MolDX: myPath Melanoma Assay -Noridian Healthcare Solutions, LLC	11/01/2019
L37887	MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-Noridian Healthcare Solutions, LLC	11/01/2019
L37891	MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-Noridian Healthcare Solutions, LLC	11/01/2019
L37897	MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-Noridian Healthcare Solutions, LLC	11/01/2019
L37899	MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer-Noridian Healthcare Solutions, LLC	11/01/2019
L37911	MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37913	MolDX: Breast Cancer Index™ (BCI) Gene Expression Test-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37915	MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L37919	MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L38018	MolDX: DecisionDX-Melanoma-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L38211	Corneal Hysteresis-Wisconsin Physicians Service Insurance Corporation	11/01/2019
L33420	Lab: Bladder/Urothelial Tumor Markers-Palmetto GBA	10/31/2019
L33646	Botulinum Toxins-National Government Services, Inc.	10/31/2019
L34037	Flow Cytometry-CGS Administrators, LLC	10/31/2019
L34175	Ophthalmic Angiography (Fluorescein and Indocyanine Green)-CGS Administrators, LLC	10/31/2019
L34393	Ocular Photography - External-CGS Administrators, LLC	10/31/2019
L34513	Lab: Flow Cytometry-Palmetto GBA	10/31/2019
L34552	Outpatient Observation Bed/Room Services-Palmetto GBA	10/31/2019
L34554	In Vitro Chemosensitivity & Chemoresistance Assays-Palmetto GBA	10/31/2019
L34565	Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia-Palmetto GBA	10/31/2019
L34567	Hospice Alzheimer's Disease & Related Disorders-Palmetto GBA	10/31/2019
L34570	Psychiatric Inpatient Hospitalization-Palmetto GBA	10/31/2019
L34594	Nerve Conduction Studies and Electromyography-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L34615	Visual Fields-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L34616	Psychiatry and Psychology Services-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L34646	Psychological and Neuropsychological Testing-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L34658	Vitamin D Assay Testing-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L34698	Cosmetic and Reconstructive Surgery-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L34761	Percutaneous Coronary Interventions-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L34891	Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy-Novitas Solutions, Inc.	10/31/2019
L35004	Surgery: Blepharoplasty-Novitas Solutions, Inc.	10/31/2019
L35038	Scanning Computerized Ophthalmic Diagnostic Imaging-Novitas Solutions, Inc.	10/31/2019
L35070	Speech - Language Pathology (SLP) Services: Communication Disorders-Novitas Solutions, Inc.	10/31/2019
L35071	MolDX: Circulating Tumor Cell Marker Assays-Palmetto GBA	10/31/2019
L35081	Nerve Conduction Studies and Electromyography-Novitas Solutions, Inc.	10/31/2019
L35249	Nerve Blocks for Peripheral Neuropathy-CGS Administrators, LLC	10/31/2019
L35408	3D Interpretation and Reporting of Imaging Studies-Novitas Solutions, Inc.	10/31/2019
L35449	Sacral Nerve Stimulation-Novitas Solutions, Inc.	10/31/2019
L35494	Mohs Micrographic Surgery-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L35498	Removal of Benign Skin Lesions-Wisconsin Physicians Service Insurance Corporation	10/31/2019
L35632	MolDX: ConfirmMDx Epigenetic Molecular Assay-Palmetto GBA	10/31/2019
L35633	MolDX: GeneSight® Assay for Refractory Depression-Palmetto GBA	10/31/2019
L35677	Infliximab -Palmetto GBA	10/31/2019
L35869	MolDX: Prolaris™ Prostate Cancer Genomic Assay-Palmetto GBA	10/31/2019
L35922	Lab: Special Histochemical Stains and Immunohistochemical Stains-Palmetto GBA	10/31/2019
L35984	MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-CGS Administrators, LLC	10/31/2019
L35986	Special Histochemical Stains and Immunohistochemical Stains-CGS Administrators, LLC	10/31/2019
L36033	MolDX: HLA-B*15:02 Genetic Testing-Palmetto GBA	10/31/2019
L36074	MolDX: Molecular RBC Phenotyping-Palmetto GBA	10/31/2019
L36089	MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Palmetto GBA	10/31/2019
L36153	MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Palmetto GBA	10/31/2019
L36402	Allergy Testing -Wisconsin Physicians Service Insurance Corporation	10/31/2019
L36464	MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Palmetto GBA	10/31/2019
L36690	Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities-CGS Administrators, LLC	10/31/2019
L36761	GlycoMark Testing for Glycemic Control-Palmetto GBA	10/31/2019
L36763	MolDX: 4Kscore Assay-Palmetto GBA	10/31/2019
L36827	MolDX: APC and MUTYH Gene Testing -Palmetto GBA	10/31/2019
L36854	MolDX: Percepta® Bronchial Genomic Classifier-Palmetto GBA	10/31/2019
L36906	GlycoMark Testing for Glycemic Control-CGS Administrators, LLC	10/31/2019
L36912	MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Palmetto GBA	10/31/2019
L36975	Bladder/Urothelial Tumor Markers-CGS Administrators, LLC	10/31/2019
L36979	MolDX: 4Kscore Assay-CGS Administrators, LLC	10/31/2019
L37033	MolDX: DecisionDx-UM (Uveal Melanoma)-Palmetto GBA	10/31/2019
L37043	MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Palmetto GBA	10/31/2019
L37130	MolDX: DecisionDx-UM (Uveal Melanoma)-CGS Administrators, LLC	10/31/2019
L37262	MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Palmetto GBA	10/31/2019
L37266	MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Palmetto GBA	10/31/2019
L37362	MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-CGS Administrators, LLC	10/31/2019
L37602	MolDX: MDS FISH-Palmetto GBA	10/31/2019
L37699	MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) -Palmetto GBA	10/31/2019
L37709	Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) -Palmetto GBA	10/31/2019
L37794	MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test -Palmetto GBA	10/31/2019
L37832	MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test-CGS Administrators, LLC	10/31/2019
L37859	MolDX: myPath Melanoma Assay -Palmetto GBA	10/31/2019
L37907	MolDX: myPath Melanoma Assay-CGS Administrators, LLC	10/31/2019
L33977	Transcranial Doppler Studies-First Coast Service Options, Inc.	10/29/2019
L36276	Erythropoiesis Stimulating Agents -First Coast Service Options, Inc.	10/29/2019
L38033	Cervical Disc Replacement-Palmetto GBA	10/28/2019
L33396	Posterior Tibial Nerve Stimulation for Voiding Dysfunction-National Government Services, Inc.	10/24/2019
L33398	Transcranial Magnetic Stimulation-National Government Services, Inc.	10/24/2019
L33423	Cardiac Computed Tomography & Angiography (CCTA)-Palmetto GBA	10/24/2019
L33428	Cosmetic and Reconstructive Surgery-Palmetto GBA	10/24/2019
L33432	Hyaluronate Polymers-Palmetto GBA	10/24/2019
L33436	Mohs Micrographic Surgery (MMS)-Palmetto GBA	10/24/2019
L33438	Octreotide Acetate for Injectable Suspension (Sandostatin LAR® depot)-Palmetto GBA	10/24/2019
L33443	Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Palmetto GBA	10/24/2019
L33444	Pulmonary Stress Testing-Palmetto GBA	10/24/2019
L33445	Removal of Benign and Malignant Skin Lesions-Palmetto GBA	10/24/2019
L33446	Respiratory Therapy and Oximetry Services-Palmetto GBA	10/24/2019
L33447	Special Electroencephalography-Palmetto GBA	10/24/2019
L33452	Virtual Colonoscopy (CT Colonography)-Palmetto GBA	10/24/2019
L33455	Wireless Gastrointestinal Motility Monitoring Systems-Palmetto GBA	10/24/2019
L33456	Total Joint Arthroplasty-Palmetto GBA	10/24/2019
L33461	Implantable Infusion Pump-Palmetto GBA	10/24/2019
L33467	Ophthalmology: Extended Ophthalmoscopy and Fundus Photography-Palmetto GBA	10/24/2019
L33473	Vertebroplasty/Kyphoplasty-Palmetto GBA	10/24/2019
L33576	Urodynamics-National Government Services, Inc.	10/24/2019
L33585	Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography-National Government Services, Inc.	10/24/2019
L34419	Homocysteine Level, Serum-Palmetto GBA	10/24/2019
L34422	Infrared Coagulation (IRC) of Hemorrhoids-Palmetto GBA	10/24/2019
L34424	Magnetic Resonance Angiography-Palmetto GBA	10/24/2019
L34425	Magnetic Resonance Imaging of the Orbit, Face, and/or Neck -Palmetto GBA	10/24/2019
L34426	Ophthalmic Angiography (Fluorescein and Indocyanine Green)-Palmetto GBA	10/24/2019
L34429	Outpatient Speech Language Pathology-Palmetto GBA	10/24/2019
L34430	Respiratory Therapy (Respiratory Care)-Palmetto GBA	10/24/2019
L34431	Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-Palmetto GBA	10/24/2019
L34433	Somatosensory Testing-Palmetto GBA	10/24/2019
L34434	Upper Gastrointestinal Endoscopy and Visualization-Palmetto GBA	10/24/2019
L34537	Vestibular Function Testing-Palmetto GBA	10/24/2019
L34544	Hospice - Liver Disease-Palmetto GBA	10/24/2019
L34547	Hospice - Neurological Conditions-Palmetto GBA	10/24/2019
L34553	Stretta Procedure-Palmetto GBA	10/24/2019
L34558	Hospice The Adult Failure To Thrive Syndrome-Palmetto GBA	10/24/2019
L34562	Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's Disease and Behavioral Disturbances-Palmetto GBA	10/24/2019
L34564	Home Health Physical Therapy-Palmetto GBA	10/24/2019
L35072	MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Palmetto GBA	10/24/2019
L35132	Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus-Palmetto GBA	10/24/2019
L35148	Lumbar Epidural Steroid Injections-Palmetto GBA	10/24/2019
L35897	Nerve Conduction Studies and Electromyography-CGS Administrators, LLC	10/24/2019
L36427	Wireless Capsule Endoscopy-Palmetto GBA	10/24/2019
L36593	Polysomnography-Palmetto GBA	10/24/2019
L36954	Noncovered Services other than CPT® Category III Noncovered Services-Palmetto GBA	10/24/2019
L37031	MolDX: BDX-XL2-Palmetto GBA	10/24/2019
L37632	Spinal Cord Stimulators for Chronic Pain-Palmetto GBA	10/24/2019
L37633	Partial Hospitalization Programs-Palmetto GBA	10/24/2019
L37635	Trigger Point Injections-Palmetto GBA	10/24/2019
L37636	Nonobstetric Pelvic Ultrasound-Palmetto GBA	10/24/2019
L37774	Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication-Palmetto GBA	10/24/2019
L37826	Lumbar Artificial Disc Replacement-Palmetto GBA	10/24/2019
L37848	Lumbar Spinal Fusion-Palmetto GBA	10/24/2019
L37857	MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test-Palmetto GBA	10/24/2019
L37873	Topical Oxygen Therapy -Palmetto GBA	10/24/2019
L37929	Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea-National Government Services, Inc.	10/24/2019
L34833	Cardiac Rhythm Device Evaluation-Novitas Solutions, Inc.	10/17/2019
L34865	Magnetic Resonance Angiography (MRA)-Novitas Solutions, Inc.	10/17/2019
L34914	Assays for Vitamins and Metabolic Function-Novitas Solutions, Inc.	10/17/2019
L34953	Cardiac Event Detection Monitoring-Novitas Solutions, Inc.	10/17/2019
L34960	Hydration Therapy-Novitas Solutions, Inc.	10/17/2019
L34975	Neurophysiology Evoked Potentials (NEPs)-Novitas Solutions, Inc.	10/17/2019
L34997	Real-Time, Outpatient Cardiac Telemetry-Novitas Solutions, Inc.	10/17/2019
L35006	Controlled Substance Monitoring and Drugs of Abuse Testing-Novitas Solutions, Inc.	10/17/2019
L35007	Vestibular and Audiologic Function Studies-Novitas Solutions, Inc.	10/17/2019
L35015	Molecular Diagnostics: Genitourinary Infectious Disease Testing-Novitas Solutions, Inc.	10/17/2019
L35016	Transesophageal Echocardiography (TEE)-Novitas Solutions, Inc.	10/17/2019
L35022	Bariatric Surgical Management of Morbid Obesity-Novitas Solutions, Inc.	10/17/2019
L35049	Monitored Anesthesia Care-Novitas Solutions, Inc.	10/17/2019
L35083	Cardiovascular Nuclear Medicine-Novitas Solutions, Inc.	10/17/2019
L35084	Non-Coronary Vascular Stents-Novitas Solutions, Inc.	10/17/2019
L35138	Routine Foot Care-Novitas Solutions, Inc.	10/17/2019
L35350	Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)-Novitas Solutions, Inc.	10/17/2019
L35360	Pulmonary Function Testing-Novitas Solutions, Inc.	10/17/2019
L35397	Non-Invasive Cerebrovascular Arterial Studies-Novitas Solutions, Inc.	10/17/2019
L35409	Non-Vascular Extremity Ultrasound-Novitas Solutions, Inc.	10/17/2019
L35434	Oximetry Services-Novitas Solutions, Inc.	10/17/2019
L35451	Non-Invasive Peripheral Venous Studies-Novitas Solutions, Inc.	10/17/2019
L35937	Lumbar Epidural Injections-National Government Services, Inc.	10/17/2019
L36241	Allergy Testing-Novitas Solutions, Inc.	10/17/2019
L36423	Strapping-Novitas Solutions, Inc.	10/17/2019
L36831	Visual Electrophysiology Testing -National Government Services, Inc.	10/17/2019
L37851	Biomarker Testing for Neuroendocrine Tumors/Neoplasms-National Government Services, Inc.	10/17/2019
L33270	Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications-First Coast Service Options, Inc.	10/15/2019
L33405	Polysomnography and Sleep Testing-First Coast Service Options, Inc.	10/15/2019
L33754	Syphilis Test-First Coast Service Options, Inc.	10/15/2019
L37800	Allergen Immunotherapy -First Coast Service Options, Inc.	10/15/2019
L33417	Allergy Skin Testing-Palmetto GBA	10/10/2019
L33418	Assays for Vitamins and Metabolic Function-Palmetto GBA	10/10/2019
L33422	Brain Natriuretic Peptide (BNP) Level-Palmetto GBA	10/10/2019
L33431	HbA1c-Palmetto GBA	10/10/2019
L33457	Cardiac Radionuclide Imaging-Palmetto GBA	10/10/2019
L33458	Chemodenervation-Palmetto GBA	10/10/2019
L33459	Computerized Axial Tomography (CT), Thorax-Palmetto GBA	10/10/2019
L33578	Transrectal Ultrasound-National Government Services, Inc.	10/10/2019
L33584	Implantable Miniature Telescope (IMT)-National Government Services, Inc.	10/10/2019
L34410	B-type Natriuretic Peptide (BNP) Testing-Palmetto GBA	10/10/2019
L34411	Blepharoplasty, Eyelid Surgery, and Brow Lift-Palmetto GBA	10/10/2019
L34413	Cataract Surgery-Palmetto GBA	10/10/2019
L34415	CT of the Abdomen and Pelvis-Palmetto GBA	10/10/2019
L34417	CT of the Head-Palmetto GBA	10/10/2019
L34454	Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-Palmetto GBA	10/10/2019
L34512	Corneal Pachymetry-Palmetto GBA	10/10/2019
L34548	Hospice Cardiopulmonary Conditions-Palmetto GBA	10/10/2019
L34549	Ambulance Services-Palmetto GBA	10/10/2019
L34555	Non-Covered Category III CPT Codes-Palmetto GBA	10/10/2019
L34560	Home Health Occupational Therapy-Palmetto GBA	10/10/2019
L34561	Home Health - Psychiatric Care-Palmetto GBA	10/10/2019
L34566	Hospice - HIV Disease-Palmetto GBA	10/10/2019
L34573	Cardiac Event Detection-Palmetto GBA	10/10/2019
L34574	Dental Services-Palmetto GBA	10/10/2019
L34576	Laparoscopic Sleeve Gastrectomy for Severe Obesity-Palmetto GBA	10/10/2019
L34580	Intravenous Immunoglobulin (IVIG)-Palmetto GBA	10/10/2019
L35048	Nerve Conduction Studies and Electromyography-Palmetto GBA	10/10/2019
L36039	Total Joint Arthroplasty-National Government Services, Inc.	10/10/2019
L36109	Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift®)-Palmetto GBA	10/10/2019
L36406	Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint-National Government Services, Inc.	10/10/2019
L36471	Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Palmetto GBA	10/10/2019
L37176	White Cell Colony Stimulating Factors-Palmetto GBA	10/10/2019
L37379	Echocardiography -Palmetto GBA	10/10/2019
L37387	Chiropractic Services-Palmetto GBA	10/10/2019
L37421	Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor-National Government Services, Inc.	10/10/2019
L37638	Health and Behavior Assessment/Intervention-Palmetto GBA	10/10/2019
L37641	Continuous Peripheral Nerve Blocks (CPNB)-Palmetto GBA	10/10/2019
L37642	Nerve Blocks and Electrostimulation for Peripheral Neuropathy-Palmetto GBA	10/10/2019
L37779	Intraoperative Radiation Therapy-Palmetto GBA	10/10/2019
L33392	Category III CPT® Codes-National Government Services, Inc.	10/03/2019
L34061	Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-CGS Administrators, LLC	10/03/2019
L34064	Panretinal (Scatter) Laser Photocoagulation-CGS Administrators, LLC	10/03/2019
L34093	Chemotherapy and Biologicals-CGS Administrators, LLC	10/03/2019
L34356	Erythropoiesis Stimulating Agents (ESA)-CGS Administrators, LLC	10/03/2019
L37485	Prostate Rectal Spacers-National Government Services, Inc.	10/03/2019
L37606	Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases-National Government Services, Inc.	10/03/2019
L37810	Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms-National Government Services, Inc.	10/03/2019
L38016	MolDX: DecisionDx-Melanoma -CGS Administrators, LLC	10/03/2019
L33282	Computed Tomographic Angiography of the Chest, Heart and Coronary Arteries-First Coast Service Options, Inc.	10/01/2019
L33380	Long-Term Wearable Electrocardiographic Monitoring (WEM)-First Coast Service Options, Inc.	10/01/2019
L33411	Surgical Management of Morbid Obesity-First Coast Service Options, Inc.	10/01/2019
L33413	Therapy and Rehabilitation Services-First Coast Service Options, Inc.	10/01/2019
L33557	Cardiac Catheterization and Coronary Angiography-National Government Services, Inc.	10/01/2019
L33559	Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)-National Government Services, Inc.	10/01/2019
L33560	Cardiovascular Nuclear Medicine-National Government Services, Inc.	10/01/2019
L33567	Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)-National Government Services, Inc.	10/01/2019
L33577	Transthoracic Echocardiography (TTE)-National Government Services, Inc.	10/01/2019
L33579	Transesophageal Echocardiography (TEE)-National Government Services, Inc.	10/01/2019
L33583	Diagnostic and Therapeutic Esophagogastroduodenoscopy-First Coast Service Options, Inc.	10/01/2019
L33619	Nonvascular Extremity Ultrasound-National Government Services, Inc.	10/01/2019
L33622	Pain Management-National Government Services, Inc.	10/01/2019
L33627	Non-Invasive Vascular Studies-National Government Services, Inc.	10/01/2019
L33633	Magnetic Resonance Angiography (MRA)-National Government Services, Inc.	10/01/2019
L33667	Duplex Scan Of Lower Extremity Arteries-First Coast Service Options, Inc.	10/01/2019
L33669	Electrocardiography-First Coast Service Options, Inc.	10/01/2019
L33670	Fundus Photography-First Coast Service Options, Inc.	10/01/2019
L33693	Non-Invasive Evaluation of Extremity Veins-First Coast Service Options, Inc.	10/01/2019
L33696	Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries-First Coast Service Options, Inc.	10/01/2019
L33707	Pulmonary Diagnostic Services-First Coast Service Options, Inc.	10/01/2019
L33745	Respiratory Therapeutic Services-First Coast Service Options, Inc.	10/01/2019
L33755	Susceptibility Studies-First Coast Service Options, Inc.	10/01/2019
L33756	Transesophageal Echocardiogram-First Coast Service Options, Inc.	10/01/2019
L33763	Vascular Stenting of Lower Extremity Arteries-First Coast Service Options, Inc.	10/01/2019
L33767	Viscosupplementation Therapy For Knee-First Coast Service Options, Inc.	10/01/2019
L33768	Transthoracic Echocardiography (TTE)-First Coast Service Options, Inc.	10/01/2019
L33815	Diagnostic Nasal Endoscopy-First Coast Service Options, Inc.	10/01/2019
L33906	Epidural-First Coast Service Options, Inc.	10/01/2019
L33912	Injection of Trigger Points-First Coast Service Options, Inc.	10/01/2019
L33923	Noninvasive Ear or Pulse Oximetry For Oxygen Saturation-First Coast Service Options, Inc.	10/01/2019
L33941	Routine Foot Care-First Coast Service Options, Inc.	10/01/2019
L33966	Vestibular Function Tests-First Coast Service Options, Inc.	10/01/2019
L33969	Diagnostic Aerosol or Vapor Inhalation-First Coast Service Options, Inc.	10/01/2019
L33974	Troponin-First Coast Service Options, Inc.	10/01/2019
L33979	Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)-Noridian Healthcare Solutions, LLC	10/01/2019
L34003	Hepatitis B Surface Antibody and Surface Antigen-First Coast Service Options, Inc.	10/01/2019
L34011	Ionized Calcium-First Coast Service Options, Inc.	10/01/2019
L34014	Magnesium-First Coast Service Options, Inc.	10/01/2019
L34018	Parathormone (Parathyroid Hormone)-First Coast Service Options, Inc.	10/01/2019
L34023	Strapping-First Coast Service Options, Inc.	10/01/2019
L34026	Trastuzumab – Trastuzumab Biologics-First Coast Service Options, Inc.	10/01/2019
L34031	Total Calcium-First Coast Service Options, Inc.	10/01/2019
L34038	B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC	10/01/2019
L34076	Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC	10/01/2019
L34080	Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC	10/01/2019
L34149	Respiratory Care (Respiratory Therapy)-Noridian Healthcare Solutions, LLC	10/01/2019
L34194	Blepharoplasty, Eyelid Surgery, and Brow Lift-Noridian Healthcare Solutions, LLC	10/01/2019
L34199	Treatment of Ulcers & Symptomatic Hyperkeratoses-Noridian Healthcare Solutions, LLC	10/01/2019
L34203	Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC	10/01/2019
L34213	Diagnostic and Therapeutic Colonoscopy-Noridian Healthcare Solutions, LLC	10/01/2019
L34217	Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC	10/01/2019
L34218	Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC	10/01/2019
L34219	Noninvasive Peripheral Arterial Studies-Noridian Healthcare Solutions, LLC	10/01/2019
L34220	Lumbar MRI-Noridian Healthcare Solutions, LLC	10/01/2019
L34221	Noninvasive Cerebrovascular Studies-Noridian Healthcare Solutions, LLC	10/01/2019
L34229	Noninvasive Peripheral Venous Studies-Noridian Healthcare Solutions, LLC	10/01/2019
L34233	Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)-Noridian Healthcare Solutions, LLC	10/01/2019
L34243	Treatment of Ulcers & Symptomatic Hyperkeratoses-Noridian Healthcare Solutions, LLC	10/01/2019
L34247	Pulmonary Function Testing-Noridian Healthcare Solutions, LLC	10/01/2019
L34313	Allergy Testing-Noridian Healthcare Solutions, LLC	10/01/2019
L34315	Electrocardiograms-Noridian Healthcare Solutions, LLC	10/01/2019
L34324	Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC	10/01/2019
L34519	Molecular Pathology Procedures-First Coast Service Options, Inc.	10/01/2019
L34575	Frequency of Hemodialysis-Palmetto GBA	10/01/2019
L34859	Nerve Conduction Studies and Electromyography-First Coast Service Options, Inc.	10/01/2019
L34912	Genetic Testing for Lynch Syndrome-First Coast Service Options, Inc.	10/01/2019
L34980	Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC	10/01/2019
L34982	Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC	10/01/2019
L35163	Plastic Surgery-Noridian Healthcare Solutions, LLC	10/01/2019
L35170	Botulinum Toxin Types A and B Policy-Noridian Healthcare Solutions, LLC	10/01/2019
L35172	Botulinum Toxin Types A and B-Noridian Healthcare Solutions, LLC	10/01/2019
L35175	MRI and CT Scans of the Head and Neck-Noridian Healthcare Solutions, LLC	10/01/2019
L35427	Hyaluronan Acid Therapies for Osteoarthritis of the Knee-Novitas Solutions, Inc.	10/01/2019
L35526	B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC	10/01/2019
L36037	Urine Drug Testing-National Government Services, Inc.	10/01/2019
L36209	Cardiology – non-emergent outpatient testing: exercise stress test, stress echo, MPI SPECT, and cardiac PET-First Coast Service Options, Inc.	10/01/2019
L36286	Blepharoplasty, Eyelid Surgery, and Brow Lift-Noridian Healthcare Solutions, LLC	10/01/2019
L36358	MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC	10/01/2019
L36362	MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC	10/01/2019
L36393	Controlled Substance Monitoring and Drugs of Abuse Testing-First Coast Service Options, Inc.	10/01/2019
L36499	BRCA1 and BRCA2 Genetic Testing-First Coast Service Options, Inc.	10/01/2019
L36668	Lab:Controlled Substance Monitoring and Drugs of Abuse Testing-Noridian Healthcare Solutions, LLC	10/01/2019
L36678	Lab: Bladder/Urothelial Tumor Markers-Noridian Healthcare Solutions, LLC	10/01/2019
L36680	Lab: Bladder/Urothelial Tumor Markers-Noridian Healthcare Solutions, LLC	10/01/2019
L36700	Serum Magnesium-Noridian Healthcare Solutions, LLC	10/01/2019
L36702	Serum Magnesium-Noridian Healthcare Solutions, LLC	10/01/2019
L36707	Lab: Controlled Substance Monitoring and Drugs of Abuse Testing-Noridian Healthcare Solutions, LLC	10/01/2019
L36767	Aortography and peripheral angiography-First Coast Service Options, Inc.	10/01/2019
L36864	GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC	10/01/2019
L36866	GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC	10/01/2019
L36868	Diagnostic and Therapeutic Colonoscopy-Noridian Healthcare Solutions, LLC	10/01/2019
L36889	Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC	10/01/2019
L36962	Vascular Endothelial Growth Factor Inhibitors for the Treatment of Ophthalmological Diseases -First Coast Service Options, Inc.	10/01/2019
L37020	Plastic Surgery-Noridian Healthcare Solutions, LLC	10/01/2019
L37027	Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC	10/01/2019
L37281	Lumbar MRI-Noridian Healthcare Solutions, LLC	10/01/2019
L37283	Electrocardiograms-Noridian Healthcare Solutions, LLC	10/01/2019
L37293	Respiratory Care (Respiratory Therapy)-Noridian Healthcare Solutions, LLC	10/01/2019
L37301	MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Noridian Healthcare Solutions, LLC	10/01/2019
L37315	MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Noridian Healthcare Solutions, LLC	10/01/2019
L37350	Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Noridian Healthcare Solutions, LLC	10/01/2019
L37368	Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Noridian Healthcare Solutions, LLC	10/01/2019
L37373	MRI and CT Scans of the Head and Neck-Noridian Healthcare Solutions, LLC	10/01/2019
L37475	Frequency of Hemodialysis-National Government Services, Inc.	10/01/2019
L37502	Frequency of Hemodialysis-Noridian Healthcare Solutions, LLC	10/01/2019
L37504	Frequency of Hemodialysis-Noridian Healthcare Solutions, LLC	10/01/2019
L37575	Frequency of Hemodialysis-CGS Administrators, LLC	10/01/2019
L37624	Helicobacter Pylori Infection Testing-Noridian Healthcare Solutions, LLC	10/01/2019
L37626	Helicobacter Pylori Infection Testing-Noridian Healthcare Solutions, LLC	10/01/2019
L33942	Physical Therapy - Home Health-CGS Administrators, LLC	09/26/2019
L34046	Speech-Language Pathology-CGS Administrators, LLC	09/26/2019
L34048	Vertebroplasty and Vertebral Augmentation (Percutaneous)-CGS Administrators, LLC	09/26/2019
L34055	Virtual Colonoscopy (CT Colonography)-CGS Administrators, LLC	09/26/2019
L34056	Urodynamics-CGS Administrators, LLC	09/26/2019
L34082	Varicose Veins of the Lower Extremity, Treatment of-CGS Administrators, LLC	09/26/2019
L34087	Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based-CGS Administrators, LLC	09/26/2019
L34171	Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation-CGS Administrators, LLC	09/26/2019
L34183	Psychiatric Inpatient Hospitalization-CGS Administrators, LLC	09/26/2019
L34200	Removal of Benign Skin Lesions-CGS Administrators, LLC	09/26/2019
L34337	Transesophageal Echocardiography (TEE)-CGS Administrators, LLC	09/26/2019
L34338	Transthoracic Echocardiography (TTE)-CGS Administrators, LLC	09/26/2019
L34394	Visual Fields Testing-CGS Administrators, LLC	09/26/2019
L34538	Hospice Determining Terminal Status-CGS Administrators, LLC	09/26/2019
L34540	Stretta Procedure-CGS Administrators, LLC	09/26/2019
L34541	Transtelephonic Spirometry-CGS Administrators, LLC	09/26/2019
L34887	Surgical Treatment of Nails-Novitas Solutions, Inc.	09/26/2019
L34938	Removal of Benign Skin Lesions-Novitas Solutions, Inc.	09/26/2019
L34998	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder -Novitas Solutions, Inc.	09/26/2019
L35009	Prostate Mapping Biopsy-Novitas Solutions, Inc.	09/26/2019
L35014	Frequency of Hemodialysis-Novitas Solutions, Inc.	09/26/2019
L35041	Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds-Novitas Solutions, Inc.	09/26/2019
L35101	Psychiatric Codes-Novitas Solutions, Inc.	09/26/2019
L35448	Independent Diagnostic Testing Facility (IDTF)-Novitas Solutions, Inc.	09/26/2019
L35450	Spinal Cord Stimulation (Dorsal Column Stimulation)-Novitas Solutions, Inc.	09/26/2019
L35906	Somatosensory Testing-CGS Administrators, LLC	09/26/2019
L36658	Proton Beam Therapy-CGS Administrators, LLC	09/26/2019
L36902	Polysomnography and Other Sleep Studies-CGS Administrators, LLC	09/26/2019
L35332	MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-CGS Administrators, LLC	09/23/2019
L36425	MolDX: Breast Cancer Assay: Prosigna -CGS Administrators, LLC	09/23/2019
L33558	Cataract Extraction-National Government Services, Inc.	09/19/2019
L33574	Visual Fields Testing-National Government Services, Inc.	09/19/2019
L33621	Ophthalmic Biometry for Intraocular Lens Power Calculation-National Government Services, Inc.	09/19/2019
L33628	Panretinal (Scatter) Laser Photocoagulation-National Government Services, Inc.	09/19/2019
L33945	Cerumen (Earwax) Removal-CGS Administrators, LLC	09/19/2019
L33947	Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)-CGS Administrators, LLC	09/19/2019
L33952	Cardiac Event Detection-CGS Administrators, LLC	09/19/2019
L33960	Cardiovascular Nuclear Medicine-CGS Administrators, LLC	09/19/2019
L33999	Corneal Pachymetry-CGS Administrators, LLC	09/19/2019
L34005	Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-CGS Administrators, LLC	09/19/2019
L34008	Computerized Corneal Topography-CGS Administrators, LLC	09/19/2019
L34062	Dialysis Access Maintenance-CGS Administrators, LLC	09/19/2019
L34081	Endoscopy by Capsule-CGS Administrators, LLC	09/19/2019
L34089	Human Papillomavirus (HPV) Testing-CGS Administrators, LLC	09/19/2019
L34090	Laser Ablation of the Prostate-CGS Administrators, LLC	09/19/2019
L34380	Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-National Government Services, Inc.	09/19/2019
L35891	Intravenous Immune Globulin-CGS Administrators, LLC	09/19/2019
L37126	Coenzyme Q10 (CoQ10)-CGS Administrators, LLC	09/19/2019
L37254	Chiropractic Services-CGS Administrators, LLC	09/19/2019
L37787	MolDX: Corus® CAD Assay-CGS Administrators, LLC	09/19/2019
L37790	Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor-CGS Administrators, LLC	09/19/2019
L38014	Corneal Hysteresis-National Government Services, Inc.	09/19/2019
L33562	Computed Tomographic (CT) Colonography for Diagnostic Uses-National Government Services, Inc.	09/12/2019
L33563	Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures-National Government Services, Inc.	09/12/2019
L33630	Corneal Pachymetry-National Government Services, Inc.	09/12/2019
L34032	Debridement Services-CGS Administrators, LLC	09/12/2019
L35013	Debridement of Mycotic Nails-Novitas Solutions, Inc.	09/12/2019
L35050	Outpatient Sleep Studies-Novitas Solutions, Inc.	09/12/2019
L36236	Autonomic Function Testing-National Government Services, Inc.	09/12/2019
L37375	Reflectance Confocal Microscopy-Novitas Solutions, Inc.	09/12/2019
L36356	Bone Mineral Density Studies-First Coast Service Options, Inc.	09/10/2019
L34592	Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation-Wisconsin Physicians Service Insurance Corporation	08/29/2019
L37725	MolDX: DecisionDx-Melanoma -Palmetto GBA	08/29/2019
L37943	Anorectal Manometry and Electromyography (EMG) of the Urinary and Anal Sphincters-First Coast Service Options, Inc.	08/12/2019
L34195	Mohs Micrographic Surgery-CGS Administrators, LLC	08/08/2019
L36296	Sacral Neuromodulation-First Coast Service Options, Inc.	08/06/2019
L36773	Intensity Modulated Radiation Therapy (IMRT) -First Coast Service Options, Inc.	07/31/2019
L33671	Diagnostic Colonoscopy-First Coast Service Options, Inc.	07/30/2019
L33817	E&M Home and Domiciliary Visits-First Coast Service Options, Inc.	07/23/2019
L33774	Wireless Capsule Endoscopy-First Coast Service Options, Inc.	07/11/2019
L33268	Bendamustine hydrochloride-First Coast Service Options, Inc.	07/01/2019
L33684	Hemophilia Clotting Factors-First Coast Service Options, Inc.	07/01/2019
L36342	Screening and Diagnostic Mammography-First Coast Service Options, Inc.	07/01/2019
L37564	Frequency of Hemodialysis-First Coast Service Options, Inc.	07/01/2019
L37923	MolDX: myPath Melanoma Assay -Wisconsin Physicians Service Insurance Corporation	07/01/2019
L33454	Varicose Veins of the Lower Extremities-Palmetto GBA	04/22/2019
L36355	Colorectal Cancer Screening-First Coast Service Options, Inc.	04/01/2019
L33416	3D Interpretation and Reporting of Imaging Studies-Palmetto GBA	03/14/2019
L33252	Psychiatric Diagnostic Evaluation and Psychotherapy Services-First Coast Service Options, Inc.	01/08/2019
L33256	3D Interpretation and Reporting of Imaging Studies-First Coast Service Options, Inc.	01/08/2019
L33267	B-Type Natriuretic Peptide (BNP)-First Coast Service Options, Inc.	01/08/2019
L33271	Biventricular Pacing/Cardiac Resynchronization Therapy-First Coast Service Options, Inc.	01/08/2019
L33274	Botulinum Toxins-First Coast Service Options, Inc.	01/08/2019
L33283	Computed Tomographic Colonography-First Coast Service Options, Inc.	01/08/2019
L33296	Noncovered Procedures - Endoscopic Treatment of Gastroesophageal Reflux Disease (GERD)-First Coast Service Options, Inc.	01/08/2019
L33382	Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions-First Coast Service Options, Inc.	01/08/2019
L33406	Posterior Tibial Nerve Stimulation (PTNS)-First Coast Service Options, Inc.	01/08/2019
L33586	Gene Expression Profiling Panel for use in the Management of Breast Cancer Treatment-First Coast Service Options, Inc.	01/08/2019
L33594	Manipulation Under Anesthesia (MUA)-First Coast Service Options, Inc.	01/08/2019
L33600	Sinus X-ray(s)-First Coast Service Options, Inc.	01/08/2019
L33609	Autonomic Function Tests-First Coast Service Options, Inc.	01/08/2019
L33615	Biofeedback-First Coast Service Options, Inc.	01/08/2019
L33618	Major Joint Replacement (Hip and Knee)-First Coast Service Options, Inc.	01/08/2019
L33661	Flow Cytometry-First Coast Service Options, Inc.	01/08/2019
L33674	Duplex Scanning-First Coast Service Options, Inc.	01/08/2019
L33685	Luteinizing Hormone-Releasing Hormone (LHRH) Analogs-First Coast Service Options, Inc.	01/08/2019
L33689	Mohs Micrographic Surgery (MMS)-First Coast Service Options, Inc.	01/08/2019
L33695	Non-invasive Extracranial Arterial Studies-First Coast Service Options, Inc.	01/08/2019
L33704	Infliximab-First Coast Service Options, Inc.	01/08/2019
L33766	Visual Field Examination-First Coast Service Options, Inc.	01/08/2019
L33771	Vitamin D; 25 hydroxy, includes fraction(s), if performed-First Coast Service Options, Inc.	01/08/2019
L33810	Computerized Corneal Topography-First Coast Service Options, Inc.	01/08/2019
L33813	Destruction of Malignant Skin Lesions-First Coast Service Options, Inc.	01/08/2019
L33818	Excision of Malignant Skin Lesions-First Coast Service Options, Inc.	01/08/2019
L33834	Health and Behavior Assessment/Intervention-First Coast Service Options, Inc.	01/08/2019
L33903	Diagnostic Laryngoscopy-First Coast Service Options, Inc.	01/08/2019
L33907	Hepatic (Liver) Function Panel-First Coast Service Options, Inc.	01/08/2019
L33908	High Sensitivity C-Reactive Protein (hsCRP)-First Coast Service Options, Inc.	01/08/2019
L33909	Incision and Drainage of Abscess of Skin, Subcutaneous and Accessory Structures-First Coast Service Options, Inc.	01/08/2019
L33911	Indocyanine-Green Angiography-First Coast Service Options, Inc.	01/08/2019
L33914	Iridotomy by Laser Surgery-First Coast Service Options, Inc.	01/08/2019
L33915	Label and Off-label Coverage of Outpatient Drugs and Biologicals-First Coast Service Options, Inc.	01/08/2019
L33917	Laser Trabeculoplasty-First Coast Service Options, Inc.	01/08/2019
L33918	Laser Treatment for Psoriasis-First Coast Service Options, Inc.	01/08/2019
L33925	Ophthalmological Diagnostic Services-First Coast Service Options, Inc.	01/08/2019
L33927	Optical Coherence Biometry-First Coast Service Options, Inc.	01/08/2019
L33929	Osteopathic Manipulative Treatment-First Coast Service Options, Inc.	01/08/2019
L33930	Paravertebral Facet Joint Blocks-First Coast Service Options, Inc.	01/08/2019
L33933	Peripheral Nerve Blocks-First Coast Service Options, Inc.	01/08/2019
L33935	Post-Voiding Residual Ultrasound-First Coast Service Options, Inc.	01/08/2019
L33939	Reduction Mammaplasty-First Coast Service Options, Inc.	01/08/2019
L33957	Sacroiliac Joint Injection-First Coast Service Options, Inc.	01/08/2019
L33958	Somatosensory Testing-First Coast Service Options, Inc.	01/08/2019
L33961	Therapy Services billed by Physicians/Nonphysician Practitioners -First Coast Service Options, Inc.	01/08/2019
L33965	Urinary Tumor Markers for Bladder Cancer-First Coast Service Options, Inc.	01/08/2019
L33968	YAG Laser Capsulotomy-First Coast Service Options, Inc.	01/08/2019
L33997	Fluorescein Angiography-First Coast Service Options, Inc.	01/08/2019
L34002	G-CSF Filgrastim-First Coast Service Options, Inc.	01/08/2019
L34006	Interspinous Process Decompression-First Coast Service Options, Inc.	01/08/2019
L34017	Ophthalmoscopy-First Coast Service Options, Inc.	01/08/2019
L34021	Sedimentation Rate, Erythrocyte-First Coast Service Options, Inc.	01/08/2019
L34022	Serum Phosphorus-First Coast Service Options, Inc.	01/08/2019
L34025	Surgical Decompression for Peripheral Polyneuropathy-First Coast Service Options, Inc.	01/08/2019
L34027	Ultrasound, Soft Tissues of Head and Neck-First Coast Service Options, Inc.	01/08/2019
L34028	Upper Eyelid and Brow Surgical Procedures-First Coast Service Options, Inc.	01/08/2019
L34043	Dysphagia/Swallowing Diagnosis and Therapy-First Coast Service Options, Inc.	01/08/2019
L34518	Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing-First Coast Service Options, Inc.	01/08/2019
L34520	Psychological and Neuropsychological Tests-First Coast Service Options, Inc.	01/08/2019
L34521	Special EEG Tests-First Coast Service Options, Inc.	01/08/2019
L36230	Evaluation and Management Services in a Nursing Facility -First Coast Service Options, Inc.	01/08/2019
L36232	Diagnostic Evaluation and Medical Management of Moderate-Severe Dry Eye Disease (DED)-First Coast Service Options, Inc.	01/08/2019
L36237	Amniotic Membrane- Sutureless Placement on the Ocular Surface -First Coast Service Options, Inc.	01/08/2019
L36238	Humanitarian Use Device (HUD) and Humanitarian Device Exemption (HDE) process-First Coast Service Options, Inc.	01/08/2019
L36377	Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities-First Coast Service Options, Inc.	01/08/2019
L36617	Chiropractic Services-First Coast Service Options, Inc.	01/08/2019
L36775	Prostatic Urethral Lift (PUL)-First Coast Service Options, Inc.	01/08/2019
L33273	Bortezomib (Velcade®)-First Coast Service Options, Inc.	01/01/2019
L33746	Rituximab (Rituxan®)-First Coast Service Options, Inc.	01/01/2019
L33797	Oxygen and Oxygen Equipment-Noridian Administrative Services	01/01/2019
L33803	Urological Supplies-Noridian Administrative Services	01/01/2019
L33972	Psychiatric Partial Hospitalization Program-First Coast Service Options, Inc.	01/01/2019
L33275	Carboplatin (Paraplatin®, Paraplatin-AQ®)-First Coast Service Options, Inc.	12/18/2018
L33278	Cetuximab (Erbitux®)-First Coast Service Options, Inc.	10/01/2018
L33723	Etoposide (Etopophos®, Toposar®, Vepesid®, VP-16)-First Coast Service Options, Inc.	10/01/2018
L33730	Paclitaxel (Taxol®)-First Coast Service Options, Inc.	10/01/2018
L33989	Docetaxel (Taxotere®)-First Coast Service Options, Inc.	10/01/2018
L34009	Chiropractic Services-Noridian Healthcare Solutions, LLC	10/01/2018
L34242	Chiropractic Services-Noridian Healthcare Solutions, LLC	10/01/2018
L33726	Gemcitabine (Gemzar)-First Coast Service Options, Inc.	06/14/2018
L33998	Fulvestrant (Faslodex®)-First Coast Service Options, Inc.	06/14/2018
L34741	Drugs and Biologics (Non-chemotherapy)-Wisconsin Physicians Service Insurance Corporation	06/01/2018
L33595	Monitored Anesthesia Care (MAC) for Certain Interventional Pain Management Services-First Coast Service Options, Inc.	01/09/2018
L33613	Chiropractic Services-National Government Services, Inc.	05/15/2017
L33727	Irinotecan-First Coast Service Options, Inc.	01/01/2017
L33263	Anorectal Manometry and EMG of the Urinary and Anal Sphincters-First Coast Service Options, Inc.	10/01/2016
L33722	Doxorubicin, Liposomal (Doxil/Lipodox)-First Coast Service Options, Inc.	10/01/2016
L34085	Post-Void Residual Urine and/or Bladder Capacity by Ultrasound-CGS Administrators, LLC	10/01/2016
L33978	Pemetrexed-First Coast Service Options, Inc.	08/18/2016
L33266	Azacitidine (Vidaza®)-First Coast Service Options, Inc.	10/01/2015
L33272	Bone and/or Joint Imaging-First Coast Service Options, Inc.	10/01/2015
L33412	Testosterone pellets (Testopel®)-First Coast Service Options, Inc.	10/01/2015
L33729	Oxaliplatin (Eloxatin®)-First Coast Service Options, Inc.	10/01/2015
L33748	Romiplostim (Nplate®)-First Coast Service Options, Inc.	10/01/2015
L33752	Topotecan Hydrochloride (Hycamtin®)-First Coast Service Options, Inc.	10/01/2015
L33808	Cataract Extraction-First Coast Service Options, Inc.	10/01/2015
L33934	Physician Certification and Recertification of Home Health Services-First Coast Service Options, Inc.	10/01/2015