Retired LCDs

Retired Local Coverage Determinations (LCDs) are available on the CMS Medicare Coverage Database (MCD). LCDs move to the MCD Archive one year after their retirement.

Retired Within One Year Archived More Than One Year Ago
California This link takes you to an external website. - Contractor ID 01111 California This link takes you to an external website.- Contractor ID 01111
Hawaii and Territories This link takes you to an external website. - Contractor ID 01211 Hawaii and Territories This link takes you to an external website. - Contractor ID 01211
Nevada This link takes you to an external website. - Contractor ID 01311 Nevada This link takes you to an external website. - Contractor ID 01311
Former Mutual of Omaha (CA, HI and Territories) This link takes you to an external website.- Contractor ID 01911 Former Mutual of Omaha (CA, HI and Territories) This link takes you to an external website.- Contractor ID 01911

Medicare Database Number LCD Title Retirement Date CPT / HCPCS Codes Referenced
L33320 Acid Phosphatase 12/13/13 84060, 84066
L33344 Ambulance Services 12/13/13 A0425, A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436
L33740 Audiological Testing: Audiological Services 12/13/13 92507, 92508, 92550, 92551, 92552, 92553, 92555, 92556, 92557, 92559, 92560, 92561, 92562, 92563, 92564, 92565, 92567, 92568, 92570, 92571, 92572, 92575, 92576 92577, 92579, 92582, 92583, 92584, 92585, 92586, 92587, 92588, 92626, 92627, 92559, 92560, 92579, 92582, 92587 92590, 92591, 92592, 92593, 92594, 92595, 92596, 92601, 92602, 92603, 92604, 92620, 92621, 92625 92626, 92627,
L33345 Blepharoplasty, Eyelid Surgery and Brow Lift 12/13/13 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924
L33346 Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) 12/13/13 75571, 75572, 75573, 75574
L33347 Cardiac Event Detection 12/13/13 93228, 93229, 93268, 93270, 93271, 93272, 93799
L33348 Cardiac Output Measurement Thoracic Electrical Bioimpedance 12/13/13 93701
L33349 Cataract Surgery in Adults 12/13/13 66830, 66840, 66850, 66852, 66920, 66940, 66982, 66983, 66984
L33350 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy 12/13/13 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45300, 45303, 45305, 45307, 45308, 45309, 45315, 45317, 45320, 45321, 45327, 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, 45345, 45355, 45378, 45379, 45380, 45381, 45382, 45383, 45384, 45385, 45386, 45387, 45391, 45392
L33351 Colorectal Cancer Screening 12/13/13 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0328
L33352 Computed Tomographic (CT) Colonography 12/13/13 74261, 74262
L33354 Dental Services 12/13/13 41820, 41821, 41822, 41823, 41828, 41830, 41850, 41870, 41872, 41874, 41899
L33355 Dynamic Electrocardiography 12/13/13 93224, 93225, 93226, 93227
L33357 Esophagogastroduodenoscopy (EGD) 12/13/13 43200, 43201, 43202, 43204, 43205, 43206, 43215, 43216, 43217, 43219, 43220, 43226, 43227, 43228, 43231, 43232, 43235, 43236, 43237, 43238, 43239, 43240, 43241, 43242, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43252, 43255, 43256, 43258, 43259, 43260, 74235, 74360, 76975
L33358  Frequency of HbA1c Testing Greater Than Every Three Months  06/12/15 83036 
L34173 High Sensitivity C-Reactive Protein (hsCRP) Testing 05/31/16 86141
L33360 Homocysteine Level, Serum 12/13/13 83090
L33366 Hyperbaric Oxygen Therapy (HBO) 12/13/13 99183, C1300
L33717 Human Papillomavirus (HPV) 01/01/15 87621
L34145 Infrared Coagulation (IRC) of Hemorrhoids 05/13/16 46930
L34238 Laparoscopic Sleeve Gastrectomy for Severe Obesity 04/30/16 43775
L33363 Magnetic Resonance Angiography (MRA) 12/13/13 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72159, 72198, 73225, 73725, 74185, C8900, C8901, C8902, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920
L33319   Microvascular Therapy in the Treatment of Peripheral Neuropathies 06/12/15  97039, 97139
L33323 Nesiritide Infusion for Heart Failure 12/13/13 J2325
L34185 Neuromuscular Junction Testing 05/31/16 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95937
L33325 Ocular Blood Flow Tests 12/13/13 0198T, 92499
L33326 One Day Stays for Chest Pain 12/13/13 NA
L34241 Ophthalmic Angiography (Fluorescein and Indocyanine Green) 05/13/16 92235, 92240
L33328 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography 12/13/13 92225, 92226, 92227, 92228, 92250
L33329 Outpatient Observation Bed/Room Services 12/13/13 G0378, G0379, 99217, 99218, 99219, 99220, 99234, 99235, 99236
L33330 Outpatient Occupational Therapy 11/06/13 G0281, G0283, G0329, 0183T, 29065, 29075, 29085, 29086, 29105, 29125, 29126, 29130, 29131, 29200, 29240, 29260, 29280, 29345, 29365, 29405, 29505, 29515, 29520, 29530, 29540, 29550, 29799, 64550, 90901, 90911, 92526, 92548, 92610, 95831, 95832, 95833, 95834, 95851, 95852, 96111, 96125, 97003, 97004, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97032, 97033, 97034, 97035, 97036, 97110, 97112, 97113, 97124, 97140, 97150, 97530, 97532, 97533, 97535, 97537, 97542, 97545, 97546, 97597, 97598, 97602, 97605, 97606, 97750, 97755, 97760, 97761, 97762
L33331 Outpatient Physical Therapy 11/06/13 G0281, G0283, G0329, 0183T, 29065, 29075, 29085, 29105, 29125, 29126, 29130, 29131, 29200, 29240, 29260, 29280, 29345, 29365, 29405, 29445, 29505, 29515, 29520, 29530, 29540, 29550, 29580, 29799, 64550, 90901, 90911, 92548, 95831, 95832, 95833, 95834, 95851, 95852, 95992, 97001, 97002, 97003, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97533, 97535, 97537, 97542, 97545, 97546, 97597, 97598, 97602, 97605, 97606, 97750, 97755, 97760, 97761, 97762, 97799
L33744 Outpatient
Speech
Language Pathology
11/06/13 31579, 92506, 92507, 92508, 92511, 92512, 92520, 92526, 92597, 92605, 92606, 92607, 92608, 92609, 92610, 92611, 92612, 92614, 92616, 92618, 92626, 92627, 92630, 92633, 95857, 96105, 96110, 96111, 96125, 97532, 97535
L33333 Psychiatric Inpatient Hospitalization 12/13/13 NA
L33335 Routine Foot Care and Debridement of Nails 12/13/13 11055, 11056, 11057, 11719, 11720, 11721, G0127
L33336 Serum Magnesium 12/13/13 83735
L33337 Surgical Debridement of Wounds 12/13/13 11042, 11043, 11044, 11045, 11046, 11047, 16020, 16025, 16030
L34160 Surgical Decompression for Peripheral Polyneuropathy 09/12/16 01470, 28035, 64702, 64704, 64708, 64712, 64714, 64722, 64726, 64727
L33339 Surgical Treatment of Nails 12/13/13 G0127, 11730, 11732, 11750, 11765,
L34161 Total Joint Arthroplasty 09/06/16 27130, 27132, 27134, 27137, 27138, 27445, 27447, 27486, 27487
L36106 Treatment of Ulcers and Symptomatic Hyperkeratoses 05/15/16 10060, 10061, 11042, 11043, 11044, 11045, 11046, 11047, 11055, 11056, 11057, 97597, 97598
L33343 Visual Fields Testing 12/13/13 92081, 92082, 92083

 

Last Updated Jun 02, 2017