All LCDS are the same for each state within a Jurisdiction. A PDF of each LCD is provided on this page. An HTML version is available in the CMS Medicare Coverage Database.

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

In the table below, select an "LCD Title" link to view the locally hosted Noridian LCD PDF.

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 Number	LCD Title	CPT / HCPCS Codes Referenced
L35526	B-type Natriuretic Peptide (BNP) Testing [PDF]	83880
L34233	Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) [PDF]	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, 11440, 11441, 11442, 11443, 11444, 11446, 17110, 17111
L34194	Blepharoplasty, Eyelid Surgery and Brow Lift [PDF]	15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909,
L35170	Botulinum Toxin Types A and B Policy [PDF]	31513, 31570, 31599, 43201, 43236, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 67345, 95873, 95874, J0585, J0586, J0587, J0588
L34324	Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography [PDF]	93015, 93016, 93017, 93018, 93320, 93321, 93325, 93350, 93351, 93352, J0153, J0395, J1245, J1250, J3490
L34203	Cataract Surgery in Adults [PDF]	66830, 66840, 66850, 66852, 66920, 66940, 66982, 66983, 66984
L37547	Chest X-Ray Policy [PDF]	71045, 71046, 71047, 71048
L37066	Coenzyme Q10 (CoQ10) [PDF]	NA
L34213	Diagnostic and Therapeutic Colonoscopy [PDF]	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
L34315	Electrocardiograms [PDF]	93000, 93005, 93010, 93040, 93041, 93042
L34993	Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy [PDF]	64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T
L36864	GlycoMark Testing for Glycemic Control [PDF]	84378
L34314	Immune Globulin Intravenous (IVIg) [PDF]	J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
L37628	In Vitro Chemosensitivity & Chemoresistance Assays [PDF]	84999, 89240
L34218	Injections-Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma [PDF]	20526, 20527, 20550, 20551, 20612, 26341, 28899, 64455, 64632
L36678	Lab: Bladder/Urothelial Tumor Markers [PDF]	86294, 86316, 86386, 88120, 88121
L36668	Lab: Controlled Substance Monitoring and Drugs of Abuse Testing [PDF]	80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659
L34215	Lab: Flow Cytometry [PDF]	88182, 88184, 88185, 88187, 88188, 88189, 86355, 86356, 86357, 86359, 86360, 86361,86367
L34982	Lumbar Epidural Injections [PDF]	62322, 62323, 62326, 62327, 64483, 64484
L34220	Lumbar MRI [PDF]	72148, 72149, 72158, A9585, Q9953
L36846	Measurement of Salivary Hormones [PDF]	84999
L35702	Mohs Micrographic Surgery [PDF]	17311, 17312, 17313, 17314, 17315
L36704	MolDX-CDD: ProMark Risk Score [PDF]	81479
L37120	MolDX: 4Kscore Assay [PDF]	81539
L37303	MolDX: AlloSure® Donor-Derived Cell-Free DNA Test [PDF]	81479
L36882	MolDX: APC and MUTYH Gene Testing [PDF]	81201, 81202, 81203, 81401, 81403, 81406, 81435, 81479
L36358	MolDX: Biomarkers in Cardiovascular Risk Assessment [PDF]	82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
L36161	MolDX: BRCA1 and BRCA2 Genetic Testing [PDF]	81162, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81432, 81445, 81455, 81479
L36380	MolDX: Breast Cancer Assay: Prosigna [PDF]	0008M, 81520
L36314	MolDx: Breast Cancer Index Genetic Assay [PDF]	81518
L35710	MolDX: Circulating Tumor Cell Marker Assays [PDF]	86152, 86153
L36327	MolDX: ConfirmMDx Epigenetic Molecular Assay [PDF]	81551
L37673	MolDX: Corus® CAD Assay [PDF]	81493
L36310	MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing [PDF]	0070U, 81225, 81226, 81227, 81355, 81479
L37616	MolDX: Cystatin C Measurement [PDF]	82610
L36343	MolDX: Decipher® Prostate Cancer Classifier Assay [PDF]	81479
L37750	MolDX: DecisionDx-Melanoma [PDF]	81599
L37070	MolDX: Decision Dx-UM (Uveal Melanoma) [PDF]	81599
L37295	MolDX: EndoPredict® Breast Cancer Gene Expression Test [PDF]	81599
L37350	MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) [PDF]	87505, 87506, 87507
L36323	MolDX: GeneSight® Assay for Refractory Depression [PDF]	81479
L36180	MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease [PDF]	81206, 81207, 81208, 81219, 81270, 81402, 81403, 81445, 81450, 81455, 81479
L36155	MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR [PDF]	81240, 81241, 81291
L36370	MolDX: Genetic Testing for Lynch Syndrome [PDF]	81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299,81300, 81301, 81317, 81318, 81319, 81403, 81435, 81479
L36364	MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay [PDF]	0047U
L37649	MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) [PDF]	81479
L36145	MolDX: HLA-B*15:02 Genetic Testing [PDF]	81381
L36551	MolDX: HLA-DQB1*06:02 Testing for Narcolepsy [PDF]	81383
L36188	MolDX: MGMT Promoter Methylation Analysis [PDF]	81287
L35160*	MolDX: Molecular Diagnostic Tests (MDT) [PDF]	0002M, 0003M, 0004M, 0006M, 0007M, 0008M, 0009M, 0011M, 0012M, 0013M, 0001U, 0002U, 0003U, 0005U, 0006U, 0007U, 0008U, 0009U, 0010U, 0011U, 0012U, 0013U, 0014U, 0016U, 0017U, 0018U, 0019U, 0021U, 0022U, 0023U, 0024U, 0025U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0035U, 0036U, 0037U, 0038U, 0039U, 0040U, 0041U, 0042U, 0043U, 0044U,0070U, 81105, 81106, 81107, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 88121, 81161, 81162, 81170, 81175, 81176, 81200, 81201, 81202, 81203, 81205, 81206, 81207, 81208, 81209, 81210, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81235, 81238, 81240, 81241, 81242, 81243, 81244, 81245, 81246,  81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81261, 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81269, 81270, 81272, 81273, 81275, 81276, 81283, 81287, 81288, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81310, 81311, 81314, 81315, 81316, 81317, 81318,81319,  81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81330, 81331,  81332, 81334, 81335, 81340, 81341, 81342, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81407, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81435, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81445, 81448, 81450, 81455, 81460, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81507, 81508, 81509, 81510, 81511, 81512, 81519, 81520, 81521, 81525, 81528, 81535, 81536, 81538, 81539, 81540, 81541, 81545, 81551, 81595, 81599, 84999, 85999, 86152, 86153, 86849, 88120, 88121
L36167	MolDX: Molecular RBC Phenotyping [PDF]	81403
L36335	MolDX: NRAS Genetic Testing [PDF]	81311, 81479
L36941	MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ [PDF]	0045U
L37305	MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer [PDF]	81541
L36886	MolDX: Percepta© Bronchial Genomic Classifier [PDF]	81479
L36348	MolDX: Prolaris™ Prostate Cancer Genomic Assay [PDF]	81541
L37080	MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease [PDF]	81479
L37299	MolDX: Prometheus IBD sgi Diagnostic Policy [PDF]	81479, 82397, 83520, 86140
L37054	MolDX: Xpresys Lung [PDF}	81599
L37373	MRI and CT Scans of the Head and Neck [PDF]	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
L35456	Nerve Blockade for Treatment of Chronic Pain and Neuropathy [PDF]	62281, 62320, 62321, 62324, 62325, 64402, 64405, 64408, 64410, 64413, 64415, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64461, 64462, 64463, 64479, 64480, 64505, 64510, 64517, 64520, 64530, 64620, 64640, 64450, 76881, 76882, 76942, 76999, 97032, 97139, G0282, G0283
L36524	Nerve Conduction Studies and Electromyography [PDF]	95873, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937, 95999, G0255, 51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95874, 95885, 95886, 95887
L36219	Non-Covered Services [PDF]	22857, 22862, 28446, 43257, 43284, 43285, 46707, 62263, 62264, 62287, 83987, 84431, 86305, 91132, 91133, 92145, 93050, 93702, 97026, 97033, 97545, 97546, 99605, 99606, 99607, J2010, J7330, 0042T, 0054T, 0055T, 0071T, 0072T, 0098T, 0100T, 0101T, 0102T, 0106T, 0107T, 0108T, 0109T, 0110T, 0111T, 0126T, 0163T, 0165T, 0174T, 0175T, 0198T, 0202T, 0205T, 0206T, 0207T, 0208T, 0209T, 0210T, 0211T, 0212T, 0219T, 0220T, 0221T, 0222T, 0232T, 0234T, 0235T, 0236T, 0237T, 0238T, 0253T, 0263T, 0264T, 0265T, 0266T, 0267T, 0268T, 0272T, 0273T, 0274T, 0278T, 0290T, 0300T, 0312T, 0313T, 0316T, 0317T, 0329T, 0330T, 0331T, 0332T, 0333T, 0335T, 0338T, 0339T, 0340T, 0341T, 0342T, 0347T, 0348T, 0349T, 0350T, 0351T, 0352T, 0353T, 0354T, 0355T, 0356T, 0357T, 0358T, 0361T, 0373T, 0374T, 0375T, 0376T, 0378T, 0379T, 0380T, 0381T, 0382T, 0383T, 0384T, 0385T, 0386T, 0396T, 0397T, 0398T, 0399T, 0400T, 0401T, 0403T, 0405T, 0408T, 0409T, 0410T, 0411T, 0412T, 0413T, 0414T, 0415T, 0416T, 0417T, 0418T, 0419T, 0420T, 0421T, 0422T, 0423T, 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, 0437T, 0439T, 0440T, 0441T, 0442T, 0443T, 0444T, 0445T, 0446T, 0447T, 0448T, 0450T, 0451T, 0452T, 0453T, 0454T, 0455T, 0456T, 0457T, 0458T, 0459T, 0460T, 0461T, 0462T, 0463T, 0464T, 0465T, 0466T, 0467T, 0468T
L34228	Percutaneous Vertebral Augmentation [PDF]	22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T
L34328	Peripheral Nerve Stimulation [PDF]	61885, 64553, 64555, 64561, 64569, 64570, 64575, 64581, 64585, 64590, 64595, 64999
L35163	Plastic Surgery [PDF]	15780, 15781, 15782, 15783, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 19316, 19318, 19324, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19366, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 30400, 30410, 30420, 30430, 30435, 30450
L36861	Polysomnography and Other Sleep Studies [PDF]	G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811
L37086	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder [PDF]	90867, 90868, 90869
L34149	Respiratory Care (Respiratory Therapy) [PDF]	G0237, G0238, G0239, 31502, 31720, 94002, 94003, 94004, 94010, 94011, 94012, 94013, 94060, 94070, 94150, 94200, 94250, 94375, 94400, 94450, 94617, 94618, 94621, 94640, 94642, 94660, 94662, 94664, 94667, 94668, 94726, 94727, 94728, 94729, 94750, 94772
L36702	Serum Magnesium [PDF]	83735
L36351 *	Special Histochemical Stains and Immunohistochemical Stains [PDF]	88312, 88313, 88341, 88342, 88344, 88360, 88361
L35136	Spinal Cord Stimulators for Chronic Pain [PDF]	63650, 63655, 63663, 63664, 63685
L34163	Total Hip Arthroplasty [PDF]	27130, 27132, 27134, 27137, 27138
L36575	Total Knee Arthroplasty [PDF]	27445, 27447, 27486, 27487
L36538	Treatment of Males with Low Testosterone [PDF]	11980, 96372, J1071, J3121, J3145, J3490
L34243	Treatment of Ulcers & Symptomatic Hyperkeratoses [PDF]	11042, 11043, 11044, 11045, 11046, 11047, 11055, 11056, 11057, 97597, 97598
L34182	Treatment of Varicose Veins of the Lower Extremities [PDF]	36468, 36470, 36471, 36475, 36476, 36478, 36479, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799, 76942, 93970, 93971
L34211	Trigger Point Injections [PDF]	20552, 20553
L36692	Vitamin D Assay Testing [PDF]	82306, 82653