Date Posted: October 8, 2026

This Local Coverage Determination (LCD) has been revised under contractor numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: October 8, 2026

Summary of Changes:

Updated link to Bibliography #40 reference.

Visit the Noridian Active LCDs webpage to view the Active LCD or access it via the CMS MCD.