Date Posted: May 14, 2026

This Local Coverage Determination (LCD) has been revised under contractor numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, and NMI), and 01312 (NV).

Effective Date: April 16, 2026

Summary of Changes:

Under Bibliography, reference #31, additional update was made to the broken link.

Visit the Noridian Active LCDs webpage to view the Active LCD or access it via the CMS MCD.