Date Posted: April 16, 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: April 16, 2026

Summary of Changes:

Under Bibliography, reference #31, updated broken link.

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