LCD Number Crosswalk

The Part B LCD numbers are available to assist providers in locating the applicable policy based on the date of service.

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ICD-10 ICD-9 LCD Title
L34188 L33677 Actinic Keratosis
L34104 L33678 Allergen Immunotherapy
L34313 L33508 Allergy Testing
L34191 L33679 Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
L35526 L34696 B-type Natriuretic Peptide (BNP) Testing
L34193 L33511 Bladder Tumor Markers
L34194 L33512 Blepharoplasty, Eyelid Surgery, and Brow Lift
L35170 L33513 Botulinum Toxin Types A and B Policy
L34212 L33680 Cardiovascular Nuclear Medicine: Myocardial Perfusion Imaging and Cardiac Blood Pool Studies
L34324 L33515 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography
L34203 L33681 Cataract Surgery in Adults
L34242 L33518 Chiropractic Services
L35710 L35217 Circulating Tumor Cell Marker Assays
L34213 L33521 Diagnostic Colonoscopy
L34315 L33523 Electrocardiograms
L34167 L33525 Erythropoietin Stimulating Agents (ESA)
L34993 L34131 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
L34215 L33526 Flow Cytometry
L35134 L33529 Implantable Infusion Pump for Treatment of Chronic Intractable Pain
L34218 L33716 Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
L34217 L33531 Intensity Modulated Radiation Therapy (IMRT)
L34314 L33532 Intravenous Immune Globulin (IVIg)
L34240 L33533 Laparoscopic Sleeve Gastrectomy for Severe Obesity
L34982 L34125 Lumbar Epidural Injections
L34220 L33534 Lumbar MRI
L35702 L33475 Mohs Micrographic Surgery
L36314 N/A MolDX: Breast Cancer Index Genetic Assay
L36327 L35846 MolDX: ConfirmMDx Epigenetic Molecular Assay
L36310 N/A MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
L36343 N/A MolDX: Decipher® Prostate Cancer Classifier Assay
L36323 L35520 MolDX: GeneSight® Assay for Refractory Depression
L35160 L33541 MolDX: Molecular Diagnostic Tests (MDT)
L36348 N/A MolDX: Prolaris™ Prostate Cancer Genomic Assay
L35456 L34777 Nerve Blockade for Treatment of Chronic Pain and Neuropathy
L34325 L33476 Nervous System Studies - Autonomic Function, Nerve Conduction and Electromyography
L36219 L35212 Non Covered Services
L34221 L33477 Noninvasive Cerebrovascular Studies
L34219 L33478 Noninvasive Peripheral Arterial Studies
L34229 L33479 Noninvasive Peripheral Venous Studies
L34228 L33500 Percutaneous Vertebral Augmentation
L34328 L33714 Peripheral Nerve and Peripheral Nerve Field Stimulation
L35163 L33482 Plastic Surgery
L34216 L33483 Polysomnography and Sleep Studies for Testing Sleep and Respiratory Disorders
L34226 L33484 Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control
L34247 L33485 Pulmonary Function Testing
L34317 L33487 Radiologic Examination, Chest
L34233 L33488 Skin Lesion (Non-Melanoma) Removal
L36351 N/A Special Histochemical Stains and Immunohistochemical Stains
L35136 L33489 Spinal Cord Stimulators for Chronic Pain
L34224 L33490 Stereotactic Body Radiation Therapy
L35133 L33491 Stereotactic Computer Assisted Volumetric &/or Navigational Procedure
L34223 L33492 Stereotactic Radiosurgery
L34163 L33494 Total Joint Arthroplasty
L34243 L33496 Treatment of Ulcers & Symptomatic Hyperkeratoses
L34209 L33497 Treatment of Varicose Veins of the Lower Extremities
L34211 L33498 Trigger Point Injections
L34205 L66499 Urodynamics
L34210 L33501 Vestibular Function Testing
L34207 L33503 Wireless Gastrointestinal Motility Monitoring Systems

 

Last Updated Sep 28, 2018