Policy Revision(s) for Local Coverage Determinations and Associated Billing and Coding Articles - Effective October 16, 2025

Date Posted: October 16, 2025

The following Local Coverage Determinations (LCDs) and associated Billing and Coding Articles have been revised under contract numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Medicare Coverage Database NumberLCD Title and Revision Number
L39881Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) - R2
L34194Blepharoplasty, Eyelid Surgery, and Brow Lift - R7
L34324Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography - R10
L37502Frequency of Hemodialysis - R4
L36864GlycoMark® Testing for Glycemic Control - R5
L38310Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea - R2
L37628In Vitro Chemosensitivity & Chemoresistance Assays - R6
L37066Lab: Coenzyme Q10 (CoQ10) - R7
L36846Measurement of Salivary Hormones - R4
L35163Plastic Surgery - R8
L34149Respiratory Care - R15
L36702Serum Magnesium - R5
L35136Spinal Cord Stimulators for Chronic Pain - R10
L36538Treatment of Males with Low Testosterone - R6
L34209Treatment of Varicose Veins of the Lower Extremities - R12
Medicare Coverage Database NumberBilling and Coding Article Title and Revision Number
A59769Billing and Coding: Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) - R1
A57190Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift - R3
A57183Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography - R7
A55675Billing and Coding: Frequency of Hemodialysis - R6
A57237Billing and Coding: GlycoMark® Testing for Glycemic Control - R3
A57948Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea - R7
A56071Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays - R7
A55769Billing and Coding: Lab: Coenzyme Q10 (CoQ10) - R4
A57612Billing and Coding: Measurement of Salivary Hormones - R2
A57221Billing and Coding: Plastic Surgery - R9
A57224Billing and Coding: Respiratory Care - R19
A57189Billing and Coding: Serum Magnesium - R10
A57791Billing and Coding: Spinal Cord Stimulators for Chronic Pain - R4
A57615Billing and Coding: Treatment of Males with Low Testosterone - R2
A57706Billing and Coding: Treatment of Varicose Veins of the Lower Extremities - R4

Effective Date: October 16, 2025

Summary of Changes:

CONTRACTOR INFORMATION:

Added: JF contractor information

This update is to consolidate JE and JF to have one unified document and policy number.

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

Last Updated Oct 15 , 2025