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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.

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LCD Title LCD Number Billing and Coding Companion Article CPT / HCPCS Codes Referenced
B-type Natriuretic Peptide (BNP) Testing L35526 A57083 83880
Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) 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 L34194 A57190 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909,
Botulinum Toxin Types A and B Policy 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 L34324 A57183 93015, 93016, 93017, 93018, 93320, 93321, 93325, 93350, 93351, 93352, J0153, J0395, J1245, J1250, J3490
Cataract Surgery in Adults L34203 A57195 66830, 66840, 66850, 66852, 66920, 66940, 66982, 66983, 66984, 66987, 66988
Chest X-Ray Policy L37547 A57497 71045, 71046, 71047, 71048
Colon Capsule Endoscopy L38824 A58436 0355T
Computed Tomography Cerebral Perfusion Analysis (CTP) L38709 A58223 0042T
Diagnostic and Therapeutic Colonoscopy 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 L34315 A57326 93000, 93005, 93010, 93040, 93041, 93042
Epidural Steroid Joint Injections for Pain Management L39240 A58993 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484
Facet Joint Interventions for Pain Management L38801 A58403 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 64999, 0213T. 0214T, 0215T, 0216T, 0217T, 0218T, 0219T, 0220T, 0221T, 0222T
Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) L37350 A56706 87505, 87506, 87507, 0097U
Frequency of Hemodialysis L37502 A55675 90999
GlycoMark Testing for Glycemic Control L36864 A57237 84378, 84999
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea L38310 A57948 0466T, 0467T, 0468T, 64568
Immune Globulin Intravenous (IVIg) L34314 A57187 J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
Implantable Continuous Glucose Monitor (I-CGM) L38657 A58133 0446T, 0447T, 0448T
In Vitro Chemosensitivity & Chemoresistance Assays L37628 A56071 84999, 89240
Injections-Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L34218 A57079 20526, 20527, 20550, 20551, 20612, 26341, 28899, 64455, 64632
Lab: Bladder/Urothelial Tumor Markers L36678 A55028 86294, 86316, 86386, 88120, 88121
Lab: Coenzyme Q10 (CoQ10) L37066 A55769 82542
Lab: Controlled Substance Monitoring and Drugs of Abuse Testing L36668 A55001

0143U, 0144U, 0145U, 0146U, 0147U, 0148U, 0149U, 0150U, 0227U, 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659
Lab: Flow Cytometry L34215 A57689 88182, 88184, 88185, 88187, 88188, 88189, 86355, 86356, 86357, 86359, 86360, 86361, 86367
Lab: Special Histochemical Stains and Immunohistochemical Stains L36351 A57611 88312, 88313, 88341, 88342, 88344, 88360, 88361
Lumbar MRI L34220 A57206 72148, 72149, 72158, A9585, Q9953
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor L37729 A57512 0398T
MDS FISH L37620 A57661 88271, 88273, 88274, 88275, 88291
Measurement of Salivary Hormones L36846 A57612 84999
Micro-Invasive Glaucoma Surgery (MIGS) L38299 A57863 0191T, 0449T, 0376T, 0450T, 0474T
Mohs Micrographic Surgery L35702 A56514 17311, 17312, 17313, 17314, 17315, 88302, 88304, 88305, 88307, 88309, 88314, 88331, 88332
MolDX: 4Kscore Assay L37120 A57336 81539
MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts L38355 A57380 81479
MolDX: APC and MUTYH Gene Testing L36882 A57352 81201, 81202, 81203, 81401, 81403, 81406, 81435, 81436, 81479
MolDX: BDX-XL2 L37054 A57356 0080U
MolDX: Biomarkers in Cardiovascular Risk Assessment L36358 A57037 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
MolDX: Blood Product Molecular Antigen Typing L38331 A57124 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81403, 0001U, 0084U, 0180U, 0181U, 0182U, 0183U, 0814U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0221U, 0222U
MolDX: BRCA1 and BRCA2 Genetic Testing L36161 A57354 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433, 81479, 0102U, 0103U, 0129U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U
MolDX: Breast Cancer Assay: Prosigna L36380 A57363 81520
MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test L37822 A57773 81518
MolDX: ConfirmMDx Epigenetic Molecular Assay L36327 A57605 81551
MolDX: Cystatin C Measurement L37616 A57643 82610
MolDX: Decision Dx-UM (Uveal Melanoma) L37070 A57621 81552
MolDX: EndoPredict® Breast Cancer Gene Expression Test L37295 A57607 81522
MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test L37887 A57419 81554
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease L36180 A57421 81206, 81207, 81208, 81219, 81270, 81279, 81339, 81450, 81479, 0027U, 0040U
MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR L36155 A57423 81240, 81241, 81291
MolDX: Genetic Testing for Lynch Syndrome L36370 A54995 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81317, 81318, 81319, 81403, 81432, 81433, 81435, 81436, 81445, 81455, 81479, 88341, 88342, 0101U, 0130U, 0134U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy L36551 A57441 81383
MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer L37897 A57664 81479
MolDX: Melanoma risk Stratification Molecular Testing L37750 A57268 81529
MolDX: MGMT Promoter Methylation Analysis L36188 A57432 81287
MolDX: Minimal Residual Disease Testing for Cancer L38814 A58454 81445, 81479
MolDX: Molecular Diagnostic Tests (MDT) L35160* A57526 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81191, 81192, 81193, 81194, 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, 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, 81277, 81278, 81279, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81305, 81306, 81307, 81308, 81309, 81310, 81311, 81312, 81313, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81338, 81339, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81347, 81348, 81349, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81362, 81363, 81364, 81374, 81377, 81381, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81419, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81445, 81448, 81450, 81455, 81460, 81465, 81470, 81471, 81479, 81493, 81504, 81507, 81518, 81519, 81520, 81521, 81522, 81523, 81525, 81528, 81529, 81540, 81541, 81542, 81546, 81551, 81552, 81554, 81595, 81599, 0004M, 0006M, 0007M, 0011M, 0012M, 0013M, 0016M, 0017M, 0001U, 0005U, 0012U, 0013U, 0014U, 0016U, 0017U, 0018U, 0019U, 0022U, 0023U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0036U, 0037U, 0040U, 0045U, 0046U, 0047U, 0048U, 0049U, 0050U, 0055U, 0056U, 0060U, 0069U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0078U, 0079U, 0084U, 0087U, 0088U, 0089U, 0090U, 0091U, 0094U, 0101U, 0102U, 0103U, 0111U, 0113U, 0114U, 0118U, 0120U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0170U, 0171U, 0172U, 0173U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0204U, 0205U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0221U, 0222U, 0228U, 0229U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U, 0242U, 0244U, 0245U, 0246U, 0250U, 0258U, 0260U, 0262U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0296U, 0297U, 0298U, 0299U, 0300U
MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing L39001 A58720 87154, 87483, 87505, 87631, 87636, 87637, 0240U, 0241U
MolDX: Molecular Testing for Solid Organ Allograft Rejection L38629 A58168 81479, 81595, 81599, 0118U
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels L37301 A57338 87631, 87636, 87637, 0240U, 0241U
MolDX: myPath Melanoma Assay L37879 A57626 81479, 0090U
MolDX: Next-Generation Sequencing for Solid Tumors L38119 A57901 81445, 81479, 0244U, 0250U
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies L38123 A57891 81450, 81479
MolDX: NRAS Genetic Testing L36335 A57486 81311, 81479
MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ L36941 A57619 0045U
MolDX: Percepta© Bronchial Genomic Classifier L36886 A57502 81479
MolDX: Pharmacogenomics Testing L38335 A57384 81220, 81225, 81226, 81227, 81231, 81232, 81247, 81283, 81306, 81328, 81335, 81350, 81355, 81374, 81377, 81381, 81383, 81479, 81406, 0029U, 0030U, 0034U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0286U
MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells L38643 A58183 81479
MolDX: Pigmented Lesion Assay L38151 A58052 0089U
MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer L38327 A57329 81479, 0288U
MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer L38647 A58181 81401, 81403, 81404, 81445, 81479, 0016M
MolDX: Prometheus IBD sgi Diagnostic Policy L37299 A57516 81479, 82397, 83520, 86140
MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease L38339 A57372 81541, 51542, 0047U
MolDX: Repeat Germline Testing L38351 A57331 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81171, 81172, 81173, 81174, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81191, 81192, 81193, 81194, 81200, 81201, 81202, 81203, 81204, 81205, 81209, 81212, 81215, 81216, 81217, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81269, 81271, 81274, 81278, 81279, 81283, 81284, 81285, 81286, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81302, 81303, 81304, 81306, 81312, 81317, 81318, 81319, 81321, 81322, 81323, 81324, 81325, 81326, 81328, 81329, 81330, 81331, 81332, 81333, 81335, 81336, 81337, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81347, 81348, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81362, 81363, 81364, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81419, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81448, 81460, 81465, 81470, 81471, 81479
MRI and CT Scans of the Head and Neck 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 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 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-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease L38613 A58095 0501T, 0502T, 0503T, 0504T
Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) L34228 A56572 22510, 22511, 22512, 22513, 22514, 22515
Peripheral Nerve Stimulation L34328 A55530 61885, 64553, 64555, 64561, 64569, 64570, 64575, 64581, 64585, 64590, 64595, 64999
Plastic Surgery 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
Platelet Rich Plasma Injections for Non-Wound Injections L39058 A58788 86965, G0460, M0076, O9020, 0232T, 0481T
Polysomnography and Other Sleep Studies L36861 A57697 G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811
ProMark Risk Score L36704 A57515 81479
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder L37086 A57692 90867, 90868, 90869
Respiratory Care (Respiratory Therapy) 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 L36702 A57189 83735
Spinal Cord Stimulators for Chronic Pain L35136 A57791 63650, 63655, 63663, 63664, 63685
Total Hip Arthroplasty L34163 A57683 27130, 27132, 27134, 27137, 27138
Total Knee Arthroplasty L36575 A57685 27445, 27447, 27486, 27487
Transurethral Waterjet Ablation of the Prostate L38705 A58227 C2596, 0421T
Treatment of Males with Low Testosterone L36538 A57615 11980, 84410, 96372, J1071, J3121, J3145, J3490
Treatment of Varicose Veins of the Lower Extremities 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 L34211 A57701 20552, 20553
Vitamin D Assay Testing L36692 A57718 82306, 82652
Wound and Ulcer Care L38902 A58565 11000, 11001, 11004, 11005, 11006, 11008, 11010, 11011, 11012, 11042, 11043, 11044, 11045, 11046, 11047, 11055, 11056, 11057, 29445, 29580, 29581, 97597, 97598, 97602, 97605, 97606, 97607, 97608, 97610

 

Last Updated Wed, 06 Jul 2022 19:14:11 +0000