Policy Revision(s) for Local Coverage Determinations - Effective February 14, 2025

Date Posted: February 20, 2025

The following Local Coverage Determinations (LCDs) have been revised under contract number: 02101 (AK), 03101 (AZ), 02201 (ID), 03201 (MT), 03301 (ND), 02301 (OR), 03401 (SD), 03501 (UT), 02401 (WA), and 03601 (WY).

Medicare Coverage Database Number LCD Title
L37618 Lab: Cystatin C Measurement
L37020 Plastic Surgery
L39060 Platelet Rich Plasma Injections for Non-Wound Injections
L39883 Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)
L39812 Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

Effective Date: February 14, 2025

Summary of Changes: Changed 'gender' to 'sex' throughout the LCD where applicable.

Visit the Noridian Active LCDs webpage to view the document or access it via the CMS Medicare Coverage Database (MCD).

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