Medicare Coverage Database (MCD)

The official LCD version is in CMS Medicare Coverage Database This link will take you to an external website.

Active LCDs

All LCDS are the same for each state within a Jurisdiction. A PDF of each LCD is provided on this page. An HTML version is available in the CMS Medicare Coverage Database.

View the ICD-9 to ICD-10 LCD number crosswalk.

In the table below, select an "LCD Title" link to view the locally hosted Noridian LCD PDF.

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 Number LCD Title CPT / HCPCS Codes Referenced
L34313 Allergy Testing [PDF] 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95070, 95071, 95076, 95079
L35526 B-type Natriuretic Peptide (BNP) Testing [PDF] 83880
L34233 Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) [PDF] 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, 11440, 11441, 11442, 11443, 11444, 11446, 17110, 17111
L36678 Bladder/Urothelial Tumor Markers [PDF] 86294, 86316, 86386, 88120, 88121
L34194 Blepharoplasty, Eyelid Surgery and Brow Lift [PDF] 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909
L35170 Botulinum Toxin Types A and B Policy [PDF] 31513, 31570, 31599, 43201, 43236, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 67345, 95873, 95874, J0585, J0586, J0587, J0588
L34324 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography [PDF] 93015, 93016, 93017, 93018, 93320, 93321, 93325, 93350, 93351, 93352, J0153, J0395, J1245, J1250, J3490
L34203 Cataract Surgery in Adults [PDF] 66830, 66840, 66850, 66852, 66920, 66940, 66982, 66983, 66984
L37547 Chest X-Ray Policy [PDF] 71045, 71046, 71047, 71048
L34242 Chiropractic Services [PDF] 98940, 98941, 98942, 98943
L37066 Coenzyme Q10 (CoQ10) [PDF] NA
L36668 Controlled Substance Monitoring and Drugs of Abuse Testing [PDF] 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659
L34213 Diagnostic and Therapeutic Colonoscopy [PDF] 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
L34315 Electrocardiograms [PDF] 93000, 93005, 93010, 93040, 93041, 93042
L34993 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy [PDF] 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T
L34215 Flow Cytometry [PDF] 86355, 86356, 86357, 86359, 86360, 86361, 86367, 88182, 88184, 88185, 88187, 88188, 88189
L36864 GlycoMark Testing for Glycemic Control [PDF] 84378
L34314 Immune Globulin Intravenous (IVIg) [PDF] J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
L37628 In Vitro Chemosensitivity & Chemoresistance Assays [PDF] 84999, 89240
L34218 Injections-Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma [PDF] 20526, 20527, 20550, 20551, 20612, 26341, 28899, 64455, 64632
L34217 Intensity Modulated Radiation Therapy (IMRT) [PDF] 49411, 77301, 77338,  G6015, G6016
L34982 Lumbar Epidural Injections [PDF] 62322, 62323, 62326, 62327, 64483, 64484
L34220 Lumbar MRI [PDF] 72148, 72149, 72158, A9585, Q9953
L36846 Measurement of Salivary Hormones [PDF] 84999
L35702 Mohs Micrographic Surgery [PDF] 17311, 17312, 17313, 17314, 17315
L36704 MolDX-CDD: ProMark Risk Score [PDF] 81479
L37303 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test [PDF] 81479
L36882 MolDX: APC and MUTYH Gene Testing [PDF] 81201, 81202, 81203, 81401, 81403, 81406, 81435, 81479
L36358 MolDX: Biomarkers in Cardiovascular Risk Assessment [PDF] 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
L36161 MolDX: BRCA1 and BRCA2 Genetic Testing [PDF] 81162, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81432, 81445, 81455, 81479
L36380 MolDX: Breast Cancer Assay: Prosigna [PDF] 0008M, 81520
L36314 MolDX: Breast Cancer Index Genetic Assay [PDF] 81479
L35710 MolDX: Circulating Tumor Cell Marker Assays [PDF] 86152, 86153
L36327 MolDX: ConfirmMDx Epigenetic Molecular Assay [PDF] 81551
L36310 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing [PDF] 81225, 81226, 81227, 81355, 81479
L36343 MolDX: Decipher® Prostate Cancer Classifier Assay [PDF] 81479
L37070 MolDX: Decision Dx-UM (Uveal Melanoma) [PDF] 81599
L37295 MolDX: EndoPredict® Breast Cancer Gene Expression Test [PDF] 81599
L36323 MolDx: GeneSight® Assay for Refractory Depression [PDF] 81479
L36180 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease [PDF] 81206, 81207, 81208, 81219, 81270, 81402, 81403, 81445, 81450, 81455, 81479
L36155 MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR [PDF] 81240, 81241, 81291
L36370 MolDX: Genetic Testing for Lynch Syndrome [PDF] 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299,81300, 81301, 81317, 81318, 81319, 81403, 81435, 81479
L36364 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay [PDF] 0047U
L37649 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) [PDF] 81479
L36145 MolDX: HLA-B*15:02 Genetic Testing [PDF] 81381
L36551 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy [PDF] 81383
L36188 MolDX: MGMT Promoter Methylation Analysis [PDF] 81287
L35160* MolDX: Molecular Diagnostic Tests (MDT) [PDF] 0001M, 0002M, 0003M, 0004M, 0006M, 0007M, 0008M, 0009M, 0011M, 0012M, 0013M, 0001U, 0002U, 0003U, 0004U, 0005U, 0006U, 0007U, 0008U, 0009U, 0010U, 0011U, 0012U, 0013U, 0014U, 0016U, 0017U, 0018U, 0019U, 0020U, 0021U, 0022U, 0023U, 0024U, 0025U, 0026U, 0027U, 0028U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0035U, 0036U, 0037U, 0038U, 0039U, 0040U, 0041U, 88105, 88106, 88107, 88107, 88108, 88109, 88110, 88111, 88112, 81120, 88121, 81161, 81162, 81170, 81175, 81176, 81200, 81201, 81202, 81203, 81205, 81206, 81207, 81208, 81209, 81210, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81235, 81238, 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, 81270,81272, 81273,  81275, 81276, 81283, 81287, 81288, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81310, 81311, 81314, 81315, 81316, 81317, 81318,81319,  81321, 81322, 81323, 81324, 81325, 81326, 81327,81328, 81330, 81331,  81332, 81334, 81335, 81340, 81341, 81342, 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, 81445, 81448, 81450, 81455, 81460, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81507, 81508, 81509, 81510, 81511, 81512, 81519, 81520, 81521, 81525, 81528, 81535, 81536, 81538, 81539, 81540, 81541, 81545, 81551, 81595, 81599, 84999, 85999, 86152, 86153, 86849, 88120, 88121, 88380, 88381
L36167 MolDX: Molecular RBC Phenotyping [PDF] 81403
L36335 MolDX: NRAS Genetic Testing [PDF] 81311, 81479
L36941 MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ [PDF] 0045U
L37305 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer [PDF] 81541
L36886 MolDX: Percepta© Bronchial Genomic Classifier [PDF] 81479
L36348 MolDX: Prolaris™ Prostate Cancer Genomic Assay [PDF] 81541
L37080 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease [PDF] 81479
L37299 MolDX: Prometheus IBD sgi Diagnostic Policy [PDF] 81479, 82397, 83520, 86140
L37054 MolDX: Xpresys Lung [PDF} 81599
L37373 MRI and CT Scans of the Head and Neck [PDF] 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
L35456 Nerve Blockade for Treatment of Chronic Pain and Neuropathy [PDF] 62281, 62320, 62321, 62324, 62325, 64402, 64405, 64408, 64410, 64413, 64415, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64461, 64462, 64463, 64479, 64480, 64505, 64508, 64510, 64517, 64520, 64530, 64620, 64640, 64450, 76881, 76882, 76942, 76999, 97032, 97139, G0282, G0283
L36524 Nerve Conduction Studies and Electromyography [PDF] 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
L36219 Non-Covered Services [PDF] 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, 0159T, 0163T, 0165T, 0174T, 0175T, 0190T, 0195T, 0196T, 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, 0337T, 0338T, 0339T, 0340T, 0341T, 0342T, 0346T, 0347T, 0348T, 0349T, 0350T, 0351T, 0352T, 0353T, 0354T, 0355T, 0356T, 0357T, 0358T, 0359T, 0360T, 0361T, 0362T, 0363T, 0364T, 0365T, 0366T, 0367T, 0368T, 0369T, 0370T, 0371T, 0372T, 0373T, 0374T, 0375T, 0376T, 0378T, 0379T, 0380T, 0381T, 0382T, 0383T, 0384T, 0385T, 0386T, 0396T, 0397T, 0398T, 0399T, 0400T, 0401T, 0402T, 0403T, 0405T, 0406T, 0407T, 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
L34221 Noninvasive Cerebrovascular Studies [PDF] 93880, 93882, 93886, 93888
L34219 Noninvasive Peripheral Arterial Studies [PDF] 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93990
L34229 Noninvasive Peripheral Venous Studies [PDF] 93970, 93971
L34228 Percutaneous Vertebral Augmentation [PDF] 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T
L34328 Peripheral Nerve Stimulation [PDF] 61885, 64550, 64553, 64555, 64561, 64569, 64570, 64575, 64581, 64585, 64590, 64595, 64999
L35163 Plastic Surgery [PDF] 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
L36861 Polysomnography and Other Sleep Studies [PDF] G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811
L34247 Pulmonary Function Testing [PDF] 94010, 94011, 94012, 94013, 94060, 94070, 94150, 94200, 94250, 94375, 94400, 94450, 94617, 94618, 94621, 94640, 94664, 94680, 94681, 94690, 94726, 94727, 94728, 94729, 94750
L37086 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder [PDF] 90867, 90868, 90869
L34149 Respiratory Care (Respiratory Therapy) [PDF] 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, 94726, 94727, 94728, 94729, 94750, 94772
L36702 Serum Magnesium [PDF] 83735
L36351 * Special Histochemical Stains and Immunohistochemical Stains [PDF] 88312, 88313, 88341, 88342, 88344, 88360, 88361
L35136 Spinal Cord Stimulators for Chronic Pain [PDF] 63650, 63655, 63663, 63664, 63685
L34224 Stereotactic Body Radiation Therapy [PDF] 77373, 77435,  G0339, G0340, G6017
L34223 Stereotactic Radiosurgery [PDF] 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77371, 77372, 77373, 77432, 77435, G0339, G0340
L34163 Total Hip Arthroplasty [PDF] 27130, 27132, 27134, 27137, 27138
L36575 Total Knee Arthroplasty [PDF] 27445, 27447, 27486, 27487
L36538 Treatment of Males with Low Testosterone [PDF] 11980, 96372, J1071, J3121, J3145, J3490
L34243 Treatment of Ulcers & Symptomatic Hyperkeratoses [PDF] 11042, 11043, 11044, 11045, 11046, 11047, 11055, 11056, 11057, 97597, 97598
L34209 Treatment of Varicose Veins of the Lower Extremities [PDF] 36470, 36471, 36475, 36476, 36478, 36479, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799, 76942, 93970, 93971
L34211 Trigger Point Injections [PDF] 20552, 20553
L36692 Vitamin D Assay Testing [PDF] 82306, 82652

 

Last Updated Nov 12, 2018