Loading
Medicare Coverage Database (MCD)
The official LCD version is in CMS Medicare Coverage Database .
- California
- Contractor ID 01111
- Hawaii and Territories
- Nevada
- CA, HI and Territories
Active LCDs
All LCDS are the same for each state within a Jurisdiction and are accessible from the table below.
- To view locally hosted PDF, select applicable LCD Title OR
- To access CMS HTML version within Medicare Coverage Database (MCD), select applicable LCD Number
View the ICD-9 to ICD-10 LCD number crosswalk.
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.
X
| LCD Title | LCD Number | Billing and Coding Companion Article | CPT / HCPCS Codes Referenced |
|---|---|---|---|
| B-type Natriuretic Peptide (BNP) Testing [PDF] | L35526 | A57083 | 83880 |
| Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) [PDF] | L34233 | A57161 | 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, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17110, 17111 |
| Blepharoplasty, Eyelid Surgery and Brow Lift [PDF] | L34194 | A57190 | 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, |
| Botulinum Toxin Types A and B Policy [PDF] | L35170 | A57185 | 31513, 31570, , 43201, 43236, 43499, 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64640, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 64999, 67345, 95873, 95874, J0585, J0586, J0587, J0588 |
| Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography [PDF] | L34324 | A57183 | 93015, 93016, 93017, 93018, 93320, 93321, 93325, 93350, 93351, 93352, J0153, J0395, J1245, J1250, J3490 |
| Cataract Surgery in Adults [PDF] | L34203 | A57195 | 66830, 66840, 66850, 66852, 66920, 66940, 66982, 66983, 66984, 66987, 66988 |
| Chest X-Ray Policy [PDF] | L37547 | A57497 | 71045, 71046, 71047, 71048 |
| Diagnostic and Therapeutic Colonoscopy [PDF] | L34213 | A57342 | 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 |
| Electrocardiograms [PDF] | L34315 | A57326 | 93000, 93005, 93010, 93040, 93041, 93042 |
| Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy [PDF] | L34993 | A57727 | 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T |
| Frequency of Hemodialysis [PDF] | L37502 | A55675 | 90999 |
| GlycoMark Testing for Glycemic Control [PDF] | L36864 | A57237 | 84378,84999 |
| Helicobacter Pylori Infection Testing [PDF] | L37624 | A57226 | 78267, 78268, 83013, 83014, 87338 |
| Immune Globulin Intravenous (IVIg) [PDF] | L34314 | A57187 | J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599 |
| In Vitro Chemosensitivity & Chemoresistance Assays [PDF] | L37628 | A56071 | 84999, 89240 |
| Injections-Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma [PDF] | L34218 | A57079 | 20526, 20527, 20550, 20551, 20612, 26341, 28899, 64455, 64632 |
| Lab: Bladder/Urothelial Tumor Markers [PDF] | L36678 | A55028 | 86294, 86316, 86386, 88120, 88121 |
| Lab: Coenzyme Q10 (CoQ10) [PDF] | L37066 | A55769 | 82542 |
| Lab: Controlled Substance Monitoring and Drugs of Abuse Testing [PDF] | L36668 | A55001 | 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659 |
| Lab: Flow Cytometry [PDF] | L34215 | A57689 | 88182, 88184, 88185, 88187, 88188, 88189, 86355, 86356, 86357, 86359, 86360, 86361,86367 |
| Lab: Special Histochemical Stains and Immunohistochemical Stains [PDF] | L36351 | A57611 | 88312, 88313, 88341, 88342, 88344, 88360, 88361 |
| Lumbar Epidural Injections [PDF] | L34982 | A57202 | 62322, 62323, 62326, 62327, 64483, 64484 |
| Lumbar MRI [PDF] | L34220 | A57206 | 72148, 72149, 72158, A9585, Q9953 |
| Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor [PDF] | L37729 | A57512 | 0398T |
| Measurement of Salivary Hormones [PDF] | L36846 | A57612 | 84999 |
| Mohs Micrographic Surgery [PDF] | L35702 | A56514 | 17311, 17312, 17313, 17314, 17315, 88302, 88304, 88305, 88307, 88309, 88314, 88331, 88332 |
| MolDX: 4Kscore Assay [PDF] | L37120 | A57336 | 81539 |
| MolDX: AlloSure® Donor-Derived Cell-Free DNA Test [PDF] | L37303 | A57456 | 81479 |
| MolDX: APC and MUTYH Gene Testing [PDF] | L36882 | A57352 | 81201, 81202, 81203, 81401, 81403, 81406, 81435, 81436, 81479 |
| MolDX: BDX-XL2 [PDF] | L37054 | A57356 | 0080U |
| MolDX: Biomarkers in Cardiovascular Risk Assessment [PDF] | L36358 | A57037 | 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141 |
| MolDX: BRCA1 and BRCA2 Genetic Testing [PDF] | L36161 | A57354 | 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81445, 81455, 814790102U, 0103U, 0129U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U |
| MolDX: Breast Cancer Assay: Prosigna [PDF] | L36380 | A57363 | 81520 |
| MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test [PDF] | L37822 | A57773 | 81518 |
| MolDX: Circulating Tumor Cell Marker Assays [PDF] | L35710 | A57815 | 86152, 86153 |
| MolDX: ConfirmMDx Epigenetic Molecular Assay [PDF] | L36327 | A57605 | 81551 |
| MolDX: Corus® CAD Assay [PDF] | L37673 | A57415 | 81493 |
| MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing [PDF] | L36310 | A57378 | 0070U, 81225, 81226, 81227, 81355, 81479 |
| MolDX: Cystatin C Measurement [PDF] | L37616 | A57643 | 82610 |
| MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease [PDF] | L37818 | A57645 | 81479 |
| MolDX: Decipher® Prostate Cancer Classifier Assay [PDF] | L36343 | A57623 | 81479 |
| MolDX: Decision Dx-UM (Uveal Melanoma) [PDF] | L37070 | A57621 | 81552 |
| MolDX: DecisionDx-Melanoma [PDF] | L37750 | A57417 | 81599 |
| MolDX: EndoPredict® Breast Cancer Gene Expression Test [PDF] | L37295 | A57607 | 81599 |
| MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test [PDF] | L37887 | A57419 | 81479 |
| MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) [PDF] | L37350 | A56706 | 87505, 87506, 87507, 0097U |
| MolDX: GeneSight® Assay for Refractory Depression [PDF] | L36323 | A57547 | 81479 |
| MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease [PDF] | L36180 | A57421 | 81206, 81207, 81208, 81219, 81270, 81402, 81403, 81445, 81450, 81455, 81479 |
| MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR [PDF] | L36155 | A57423 | 81240, 81241, 81291 |
| MolDX: Genetic Testing for Lynch Syndrome [PDF] | L36370 | A54995 | 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299,81300, 81301, 81317, 81318, 81319, 81403, 81435, 81436, 81445, 81455, 81479, 88341, 88342, 0101U, 0130U, 0134U |
| MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay [PDF] | L36364 | A56371 | 0047U |
| MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) [PDF] | L37649 | A57425 | 81479 |
| MolDX: HLA-B*15:02 Genetic Testing [PDF] | L36145 | A57466 | 81381 |
| MolDX: HLA-DQB1*06:02 Testing for Narcolepsy [PDF] | L36551 | A57441 | 81383 |
| MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer [PDF] | L37897 | A57664 | 81479 |
| MolDX:MDS FISH [PDF] | L37620 | A57661 | 88271, 88273, 88274, 88275, 88291 |
| MolDX: MGMT Promoter Methylation Analysis [PDF] | L36188 | A57432 | 81287 |
| MolDX: Molecular Diagnostic Tests (MDT) [PDF] | L35160* | 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, 0084U, 0085U, 0086U, 0087U, 0088U, 0089U, 0090U, 0091U, 0092U, 0093U, 0094U, 0095U, 0096U, 0097U, 0098U, 0099U, 0100U, 0101U, 0102U, 0103U, 0104U, 81105, 81106, 81107, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 88121, 81161, 81162, 81163, 81164, 91165, 81166, 81167, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81200, 81201, 81202, 81203, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81235, 81236, 81235, 81237, 81238, 81239, 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, 81271, 81272, 81273, 81274, 81275, 81276, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81305, 81306, 81310, 81311, 81312, 81314, 81315, 81316, 81317, 81318,81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81340, 81341, 81342, 81343, 81344, 81345, 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, 81443, 81445, 81448, 81450, 81455, 81460, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81507, 81508, 81509, 81510, 81511, 81512, 81518, 81519, 81520, 81521, 81525, 81528, 81535, 81536, 81538, 81539, 81540, 81541, 81545, 81551, 81595, 81596, 81599, 84999, 85999, 86152, 86153, 86849, 88120, 88121 | |
| MolDX: Molecular RBC Phenotyping [PDF] | L36167 | A57444 | 0001U |
| MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels [PDF] | L37301 | A57338 | 87631, 87632, 87633, 0098U, 0099U, 0100U, 0115U |
| MolDX: myPath Melanoma Assay [PDF] | L37879 | A57626 | 81479, 0090U |
| MolDX: NRAS Genetic Testing [PDF] | L36335 | A57486 | 81311, 81479 |
| MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC) [PDF] | L37746 | A57601 | 81479 |
| MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ [PDF] | L36941 | A57619 | 0045U |
| MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer [PDF] | L37305 | A56371 | 0047U |
| MolDX: Percepta© Bronchial Genomic Classifier [PDF] | L36886 | A57502 | 81479 |
| MolDX: Prolaris™ Prostate Cancer Genomic Assay [PDF] | L36348 | A57509 | 81541 |
| MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease [PDF] | L37080 | A57514 | 81479 |
| MolDX: ProMark Risk Score [PDF] | L36704 | A57515 | 81479 |
| MolDX: Prometheus IBD sgi Diagnostic Policy [PDF] | L37299 | A57516 | 81479, 82397, 83520, 86140 |
| MRI and CT Scans of the Head and Neck [PDF] | L37373 | A57204 | 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 |
| Nerve Blockade for Treatment of Chronic Pain and Neuropathy [PDF] | L35456 | A56034 | 62281, 62320, 62321, 62324, 62325, , 64405, 64408, 64415, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64451, 64461, 64462, 64463, 64479, 64480, 64505, 64510, 64517, 64520, 64530, 64620, 64640, 64450, 76881, 76882, 76942, 76999, 97032, 97139, G0282, G0283 |
| Nerve Conduction Studies and Electromyography [PDF] | L36524 | A54969 | 51785, 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 |
| Non-Covered Services [PDF] | L36219 | A57641 | 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 |
| Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) [PDF] | L34228 | A56572 | 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T |
| Peripheral Nerve Stimulation [PDF] | L34328 | A55530 | 61885, 64553, 64555, 64561, 64569, 64570, 64575, 64581, 64585, 64590, 64595, 64999 |
| Plastic Surgery [PDF] | L35163 | A57221 | 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 |
| Polysomnography and Other Sleep Studies [PDF] | L36861 | A57697 | G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811 |
| Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder [PDF] | L37086 | A57692 | 90867, 90868, 90869 |
| Respiratory Care (Respiratory Therapy) [PDF] | L34149 | A57224 | 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, 94669, 94726, 94727, 94728, 94729, 94750, 94772 |
| Serum Magnesium [PDF] | L36702 | A57189 | 83735 |
| Spinal Cord Stimulators for Chronic Pain [PDF] | L35136 | A57791 | 63650, 63655, 63663, 63664, 63685 |
| Total Hip Arthroplasty [PDF] | L34163 | A57683 | 27130, 27132, 27134, 27137, 27138 |
| Total Knee Arthroplasty [PDF] | L36575 | A57685 | 27445, 27447, 27486, 27487 |
| Treatment of Males with Low Testosterone [PDF] | L36538 | A57615 | 11980, 84410, 96372, J1071, J3121, J3145, J3490 |
| Treatment of Ulcers & Symptomatic Hyperkeratoses [PDF] | L34243 | A57459 | 11042, 11043, 11044, 11045, 11046, 11047, 11055, 11056, 11057, 97597, 97598 |
| Treatment of Varicose Veins of the Lower Extremities [PDF] | L34209 | A57706 | 36299, 36465, 36466, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799, , 93970, 93971 |
| Trigger Point Injections [PDF] | L34211 | A57701 | 20552, 20553 |
| Vitamin D Assay Testing [PDF] | L36692 | A57718 | 82306, 82652 |
Last Updated Mar 24, 2020