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Medicare Coverage Database (MCD)

The official LCD version is in CMS Medicare Coverage Database This link will take you to an external website.

Last Updated Sep 13, 2016

Active LCDs

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.

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LCD Number LCD Title CPT / HCPCS Codes Referenced
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, 11401, 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
L34054 B-type Natriuretic Peptide (BNP) Testing [PDF] 83880
L35710 Circulating Tumor Cell Marker Assays [PDF] 86152, 86153
L36668 Controlled Substance Monitoring and Drugs of Abuse Testing [PDF] 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659
L34133 Cranial Computerized Tomography (CCT) Scans [PDF] 70450, 70460, 70470
L34165 Erythropoietin Stimulating Agents [PDF] J0881, J0882, J0885, , Q4081
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
L34215 Flow Cytometry [PDF] 88182, 88184, 88185, 88187, 88188, 88189, 86355, 86356, 86357, 86359, 86360, 86361,86367
L34218 Injections-Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma [PDF] 20526, 20527, 20550, 20551, 20612, 26341, 64455
L34314 Intravenous Immune Globulin (IVIg) [PDF] J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
L34982 Lumbar Epidural Injections [PDF] 62311, 62319, 64483, 64484
L35702 Mohs Micrographic Surgery [PDF] 17311, 17312, 17313, 17314, 17315
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
L36314 MolDx: Breast Cancer Index Genetic Assay [PDF] 81479
L36327 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay [PDF] 81479
L36343 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay [PDF] 81479
L36364 MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay [PDF] 81479
L36194 MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing [PDF] 81445, 81455, 81479
L36348 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay [PDF] 81479
L36557 MolDX: Chromosome 1p/19q Deletion Analysis [PDF] 81402, 88367, 88368, 88369, 88373
L36309 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing [PDF] 81225, 81226, 81227, 81355
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
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] 0001M, 0002M, 0003M, 0004M, 0006M, 0008M, 0009M, 81161, 81201, 81202, 81203, 81206, 81207, 81208, 81210, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81225, 81226, 81235, 81240, 81240, 81241, 81245, 81246, 81256, 81261, 81262, 81263, 81264, 81265, 81270, 81275, 81287, 81288, 81291, 81293, 81294, 81296, 81297, 81298, 81299, 81300, 81301, 81310, 81315, 81316, 81317, 81318, 81321, 81322, 81323, 81327, 81332, 81340, 81341, 81342, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81413, 81414, 81422, 81439, 81539, 81479, 81599, 84999, 85999, 86849, 87999, 88199, 88299, 88380, 88381, 88399, 89398, G0452
L36167 MolDX: Molecular RBC Phenotyping [PDF] 81403
L36335 MolDX: NRAS Genetic Testing [PDF] 81311, 81479
L35456 Nerve Blockade for Treatment of Chronic Pain and Neuropathy [PDF] 62281, 62310, 62318, 64402, 64405, 64408, 64410, , 64413, 64415, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64455, 64461, 64462, 64463, 64479, 64480, 64505, 64508, 64510, 64517, 64520, 64530, 64620, 64632, 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, 32998, 34806, 43210, 43257, 46707, 62263, 62264, 62287, 83987, 84145, 84431, 86305, 91132, 91133, 92145, 93050, 93702, 93982, 97026, 97033, 97545, 97546, 99605, 99606, 99607, J2010, J7330, 0019T, 0042T, 0054T, 0055T, 0071T, 0072T, 0098T, 0100T, 0101T, 0102T, 0106T, 0107T, 0108T, 0109T, 0110T, 0111T, 0126T, 0159T, 0163T, 0165T, 0169T, 0174T, 0175T, 0190T, 0195T, 0196T, 0198T, 0202T, 0205T, 0206T, 0207T, 0208T, 0209T, 0210T, 0211T, 0212T, 0219T, 0220T, 0221T, 0222T, 0232T, 0234T, 0235T, 0236T, 0237T, 0238T, 0253T, 0254T, 0255T, 0263T, 0264T, 0265T, 0266T, 0267T, 0268T, 0272T, 0273T, 0274T, 0275T, 0278T, 0286T, 0287T, 0288T, 0289T, 0290T, 0291T, 0292T, 0293T, 0294T, 0299T, 0300T, 0301T, 0302T, 0304T, 0305T, 0306T, 0310T, 0312T, 0313T, 0316T, 0317T, 0329T, 0330T, 0331T, 0332T, 0333T, 0335T, 0337T, 0338T, 0339T, 0340T, 0341T, 0342T, 0346T, 0347T, 0348T, 0349T, 0350T, 0351T, 0352T, 0353T, 0354T, 0355T, 0356T, 0357T, 0358T, 0359T, 0360T, 0361T, 0362T, 0363T, 0364T, 0365T, 0366T, 0367T, 0368T, 0369T, 0370T, 0371T, 0372T, 0373T, 0374T, 0375T, 0376T, 0378T, 0379T, 0380T, 0381T, 0382T, 0383T, 0384T, 0385T, 0386T, 0387T, 0388T, 0389T, 0390T, 0391T, 0392T, 0393T, 0396T, 0397T, 0398T, 0399T, 0400T, 0401T, 0402T, 0403T, 0405T, 0406T, 0407T, 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, 0438T, 0439T, 0440T, 0441T, 0442T, 0443T, 0444T, 0445T
L34228 Percutaneous Vertebral Augmentation [PDF] 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T
L34176 Polysomnography and Sleep Studies [PDF] G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811
L34149 Respiratory Care (Respiratory Therapy ) [PDF] G0237, G0238, G0239, 31500, 31502, 31720, 92950, 94002, 94003, 94004, 94010, 94011, 94012, 94013, 94060, 94070, 94150, 94200, 94250, 94375, 94400, 94450, 94620, 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, 63661, 63662, 63663, 63664, 63685, 63688, 95970, 95971, 95972, L8680
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] 10060, 10061, 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
L36992 Vitamin D Assay Testing [PDF] 82306, 82653

Last Updated Mar 21, 2017