Policy Revision(s) for Local Coverage Determinations and Associated Billing and Coding Articles - Effective October 23, 2025

Date Posted: October 23, 2025

The following Local Coverage Determinations (LCDs) and associated Billing and Coding Articles have been revised under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, and NMI), and 01312 (NV).

Medicare Coverage Database Number LCD Title and Revision Number
L39116 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound - R1
L37054 BDX-XL2 - R4
L34233 Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) - R10
L38657 Implantable Continuous Glucose Monitor (I-CGM) - R6
L34220 Lumbar MRI - R10
L37620 MDS FISH - R6
L38299 Micro-Invasive Glaucoma Surgery (MIGS) - R7
L39810 Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) - R3
L35702 Mohs Micrographic Surgery - R10
L37373 MRI and CT Scans of the Head and Neck - R9
L36524 Nerve Conduction Studies and Electromyography - R8
L34328 Peripheral Nerve Stimulation - R11
L36704 ProMark Risk Score - R7
L34211 Trigger Point Injections - R10
Medicare Coverage Database Number Billing and Coding Article Title and Revision Number
A58865 Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound - R7
A57356 Billing and Coding: BDX-XL2 - R4
A57161 Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) - R6
A58133 Billing and Coding: Implantable Continuous Glucose Monitor (I-CGM) - R7
A57206 Billing and Coding: Lumbar MRI - R8
A57661 Billing and Coding: MDS FISH - R5
A57863 Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) - R9
A59695 Billing and Coding: Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) - R1
A56514 Billing and Coding: Mohs Micrographic Surgery - R7
A57204 Billing and Coding: MRI and CT Scans of the Head and Neck - R13
A54969 Billing and Coding: Nerve Conduction Studies and Electromyography - R13
A55530 Billing and Coding: Peripheral Nerve Stimulation - R12
A57515 Billing and Coding: ProMark Risk Score - R4
A57701 Billing and Coding: Trigger Point Injections - R8

Effective Date: October 23, 2025

Summary of Changes:

CONTRACTOR INFORMATION:

Added: JF contractor information

This update is to consolidate JE and JF to have one unified document and policy number.

Visit the Noridian Active LCDs webpage or Noridian Billing and Coding Articles webpages to view the document or access it via the CMS Medicare Coverage Database (MCD).

Last Updated Oct 23 , 2025