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Access LCD or Article: Select the LCD or Article number in the table below to view the policy or article on the Medicare Coverage Database (MCD).

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Print the LCD or Article: Select the LCD or Article number in the table below to view the policy or article on the Medicare Coverage Database (MCD).

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View the ICD-9 to ICD-10 LCD number crosswalk.

Once you access the LCD, the "Coding Guidelines" can be found under the heading, "LCD Attachments" near the end of the document. Note: All CPT/HCPCS codes listed are mentioned in the LCD, but are not necessarily subject to diagnosis codes or coverage criteria.

 
LCD Title LCD Number Billing and Coding Companion Article CPT / HCPCS Codes Referenced
Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin L39396 A59175 38240
Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound L39116 A58865 Q4112, Q4139, Q4145, Q4149, Q4155, Q4162, Q4168, Q4171, Q4174, Q4177, Q4185, Q4189, Q4192, Q4206, Q4212, Q4213, Q4215, Q4230, Q4231, Q4233, Q4240, Q4241, Q4242, Q4244, Q4245, Q4246
Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) L39881 A59769 0623T, 0624T, 0625T, 0626T
B-type Natriuretic Peptide (BNP) Testing L35526 A57083 83880
BDX-XL2 L37054 A57356 0080U
Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) L34233 A57161 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17110, 17111
Blepharoplasty, Eyelid Surgery and Brow Lift L34194 A57190 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909
Botulinum Toxin Types A and B Policy L35170 A57185 31513, 31570, 43201, 43236, 43499, 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64640, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 64999, 67345, 95873, 95874, J0585, J0586, J0587, J0588
Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography L34324 A57183 93015, 93016, 93017, 93018, 93320, 93321, 93325, 93350, 93351, 93352, J0153, J0395, J1245, J1250, J3490
Cataract Surgery in Adults L34203 A57195 66830, 66840, 66850, 66852, 66920, 66940, 66982, 66983, 66984, 66987, 66988
Cervical Fusion L39758 A59624

22548, 22551, 22552, 22554, 22585, 22590, 22595, 22600, 22614, 22800, 22802, 22808, 22810, 22812
Chest X-Ray Policy L37547 A57497 71045, 71046, 71047, 71048
Colon Capsule Endoscopy L38824 A58436 91113
Computed Tomography Cerebral Perfusion Analysis (CTP) L38709 A58223 0042T
Diagnostic and Therapeutic Colonoscopy L34213 A57342 44388, 44389, 44390, 44391, 44392, 44394, 44401, 44402, 44404, 44405, 44406, 44407, 45378, 45379, 45380, 45381, 45382, 45384, 45385, 45386, 45388, 45389, 45391, 45392, 45393
Electrocardiograms L34315 A57326 93000, 93005, 93010, 93040, 93041, 93042, 93319, 93593, 93594, 93595, 93596, 93597, 93598
Epidural Steroid Joint Injections for Pain Management L39240 A58993 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484
Facet Joint Interventions for Pain Management L38801 A58403 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 0213T. 0214T, 0215T, 0216T, 0217T, 0218T, 0219T, 0220T, 0221T, 0222T
Frequency of Hemodialysis L37502 A55675 90999
GlycoMark Testing for Glycemic Control L36864 A57237 84378, 84999
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea L38310 A57948 64582, 64583, 64584
Immune Globulin Intravenous (IVIg) L34314 A57187 J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
Implantable Continuous Glucose Monitor (I-CGM) L38657 A58133 0446T, 0447T, 0448T
Injections-Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L34218 A57079 20526, 20527, 20550, 20551, 20612, 26341, 28899, 64455, 64632
Intraosseous Basivertebral Nerve Ablation L39642 A59466 64628, 64629
In Vitro Chemosensitivity & Chemoresistance Assays L37628 A56071 84999, 89240, 0564T, 0083U
Lab: Bladder/Urothelial Tumor Markers L36678 A55028 86294, 86316, 86386, 88120, 88121
Lab: Coenzyme Q10 (CoQ10) L37066 A55769 82542
Lab: Cystatin C Measurement L37616 A57643 82610
Lab: Flow Cytometry L34215 A57689 88182, 88184, 88185, 88187, 88188, 88189, 86053, 86355, 86356, 86357, 86359, 86360, 86361, 86363, 86367
Lab: Special Histochemical Stains and Immunohistochemical Stains L36351 A57611 88312, 88313, 88341, 88342, 88344, 88360, 88361
Lumbar MRI L34220 A57206 72148, 72149, 72158, A9585, Q9953
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor L37729 A57512 0398T
MDS FISH L37620 A57661 88271, 88273, 88274, 88275, 88291
Measurement of Salivary Hormones L36846 A57612 84999
Micro-Invasive Glaucoma Surgery (MIGS) L38299 A57863 66989, 66991, 0449T, 0450T, 0474T, 0671T
Mohs Micrographic Surgery L35702 A56514 17311, 17312, 17313, 17314, 17315, 88302, 88304, 88305, 88307, 88309, 88314, 88331, 88332
MRI and CT Scans of the Head and Neck L37373 A57204 70336, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70540, 70542, 70543, 70551, 70552, 70553, 70557, 70558, 70559, 72125, 72126, 72127, 72141, 72142, 72156
Nerve Blockade for Treatment of Chronic Pain and Neuropathy L35456 A56034 62281, 62324, 62325, 64405, 64408, 64415, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64451, 64461, 64462, 64463, 64505, 64510, 64517, 64520, 64530, 64620, 64640, 64999, 64450, 76881, 76882, 76942, 76999, 97032, 97139, G0282, G0283
Nerve Conduction Studies and Electromyography L36524 A54969 51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937, 95999, G0255
Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease L38613 A58095 0501T, 0502T, 0503T, 0504T
Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) L34228 A56572 22510, 22511, 22512, 22513, 22514, 22515
Peripheral Nerve Stimulation L34328 A55530 61885, 64553, 64555, 64561, 64569, 64570, 64575, 64581, 64585, 64590, 64595, 64999
Plastic Surgery L35163 A57221 15780, 15781, 15782, 15783, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 30400, 30410, 30420, 30430, 30435, 30450
Platelet Rich Plasma Injections for Non-Wound Injections L39058 A58788 86965, G0460, G0465, M0076, P9020, 0232T
Polysomnography and Other Sleep Studies L36861 A57697 G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811
ProMark Risk Score L36704 A57515 81479
Respiratory Care L34149 A57224 G0237, G0238, G0239, 31502, 31720, 94002, 94003, 94004, 94010, 94011, 94012, 94013, 94060, 94070, 94150, 94200, 94375, 94450, 94617, 94618, 94619, 94621, 94640, 94642, 94660, 94662, 94664, 94667, 94668, 94669, 94680, 94681, 94690, 94726, 94727, 94728, 94729, 94772
Sacroiliac Joint Injections and Procedures L39462 A59244 27096, 64451, 64625, 77002, 77012, G0260
Serum Magnesium L36702 A57189 83735
Skin Substitutes Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers L39760 A59626 15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, A2001, A2002, A2004, A2005, A2006, A2007, A2008, A2009, A2010, A2011, A2012, A2014, A2015, A2016. A2018, A2019, A2020, A2021, A2022, A2023, A2024, A2025, C5271, C5272, C5273, C5274, C5275, C5276, C5277, C5278, C9358, C9360, C9363, C9364, Q4101, Q4102, Q4103, Q4104, Q4105, Q4106, Q4107, Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4116, Q4117, Q4118, Q4121, Q4122, Q4123, Q4124, Q4125, Q4126, Q4127, Q4128, Q4130, Q4132, Q4133, Q4134, Q4135, Q4136, Q4137, Q4138, Q4139, Q4140, Q4141, Q4142, Q4143, Q4145, Q4146, Q4147, Q4148, Q4149, Q4150, Q4151, Q4152, Q4153, Q4154, Q4155, Q4156, Q4157, Q4158, Q4159, Q4160, Q4161, Q4162, Q4163, Q4164, Q4165, Q4166, Q4167, Q4168, Q4169, Q4170, Q4171, Q4173, Q4174, Q4175, Q4176, Q4177, Q4178, Q4179, Q4180, Q4181, Q4182, Q4183, Q4184, Q4185, Q4186, Q4187, Q4188, Q4189, Q4190, Q4191, Q4192, Q4193, Q4194, Q4195, Q4196, Q4197, Q4198, Q4199, Q4200, Q4201, Q4202, Q4203, Q4204, Q4205, Q4206, Q4208, Q4209, Q4211, Q4212, Q4213, Q4214, Q4215, Q4216, Q4217, Q4218, Q4219, Q4220, Q4221, Q4222, Q4225, Q4226, Q4227, Q4229, Q4230, Q4231, Q4232, Q4233, Q4234, Q4235, Q4236, Q4237, Q4238, Q4239, Q4240, Q4241, Q4242, Q4245, Q4246, Q4247, Q4248, Q4249, Q4250, Q4251, Q4252, Q4253, Q4254, Q4255, Q4256, Q4257, Q4258, Q4259, Q4260, Q4261, Q4262, Q4263, Q4264, Q4265, Q4266, Q4267, Q4268, Q4269, Q4270, Q4271, Q4272, Q4273, Q4274, Q4275, Q4276, Q4278, Q4279, Q4280, Q4281, Q4282, Q4283, Q4284, Q4285, Q4286, Q4287, Q4288, Q4289, Q4290, Q4291, Q4292, Q4293, Q4294, Q4295, Q4296, Q4297, Q4298, Q4299, Q4300, Q4301, Q4302, Q4303, Q4304, Q4305, Q4306, Q4307, Q4308, Q4309, Q4310
Spinal Cord Stimulators for Chronic Pain L35136 A57791 63650, 63655, 63663, 63664, 63685
Total Hip Arthroplasty L34163 A57683 27130, 27132, 27134, 27137, 27138
Total Knee Arthroplasty L36575 A57685 27445, 27447, 27486, 27487
Transcranial Magnetic Stimulation (TMS) L37086 A57692 90867, 90868, 90869
Transurethral Waterjet Ablation of the Prostate L38705 A58227 C2596, 0421T
Treatment of Males with Low Testosterone L36538 A57615 11980, 84410, 96372, J1071, J3121, J3145, J3490
Treatment of Varicose Veins of the Lower Extremities L34209 A57706 36299, 36465, 36466, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799, 93970, 93971
Trigger Point Injections L34211 A57701 20552, 20553
Urine Drug Testing L36668 A55001 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659
Vitamin D Assay Testing L36692 A57718 82306, 82652
Wound and Ulcer Care L38902 A58565 11000, 11001, 11004, 11005, 11006, 11008, 11010, 11011, 11012, 11042, 11043, 11044, 11045, 11046, 11047, 11055, 11056, 11057, 29445, 29580, 29581, 97597, 97598, 97602, 97605, 97606, 97607, 97608, 97610

 

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