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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 Northern This link takes you to an external website. - Contractor ID 01112 California Northern This link takes you to an external website. - Contractor ID 01112
California Southern This link takes you to an external website. - Contractor ID 01182 California Southern This link takes you to an external website. - Contractor ID 01182
Hawaii and Territories This link takes you to an external website. - Contractor ID 01212 Hawaii and Territories This link takes you to an external website. - Contractor ID 01212
Nevada This link takes you to an external website. - Contractor ID 01312 Nevada This link takes you to an external website. - Contractor ID 01312

Medicare Database Number LCD Title Retirement Date CPT / HCPCS Codes Referenced
L33505 Ablative Therapy: Intra-thoracic and Intra-abdominal 12/13/13 19105, 20982, 20999, 32999, 47370, 47371, 47380, 47381, 49203-49205, 50250, 50542, 50592, 50593, 76940, 77013, 77022, 0071T, 0072T
L34188 Actinic Keratosis 05/01/16 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17000, 17003, 17004, 96567, J7308, J7309
L34104 Allergen Immunotherapy 05/13/16 95115, 95117, 95144, 95145, 95146, 95147, 95148, 95149, 95165, 95180
L33509 Ambulance Services 12/13/13 99465, 99466, A0382, A0384, A0392, A0394, A0396, A0398, A0420, A0422, A0424, A425, A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436, A0888, A0999
L34191 Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectral or Urethral Sphincters 04/29/16 51784, 51785, 90901, 90911, 91117, 91122
L34212 Cardiovascular Nuclear Medicine: Myocardial Perfusion Imaging and Cardiac Blood Pool Studies 05/13/16 78451, 78452, 78453, 78454, 78472, 78473, 78481, 78483, 78494, 78496, 93015, 93016, 93017, 93018, A4641, A9500, A9502, A9505, A9520, A9560, J0153, J0395, J1245, J1250, J3490
L33683 Category III CPT Codes 07/08/15 0042T, 0052T, 0053T, 0058T, 0071T, 0072T, 0095T, 0098T, 0099T, 0100T, 0101T, 0103T, 0106T, 0107T, 0108T, 0109T, 0110T, 0111T, 0123T, 0126T, 0169T, 0174T, 0175T, 0178T, 0179T, 0180T, 0184T, 0188T, 0189T, 0190T, 0198T, 0200T, 0201T, 0202T, 0205T, 0206T, 0207T, 0208T, 0209T, 0210T, 0211T, 0212T, 0219T, 0220T, 0221T, 0222T, 0223T, 0224T, 0225T, 0228T, 0229T, 0230T, 0231T, 0232T, 0233T, 0234T, 0235T, 0236T, 0237T, 0238T, 0240T, 0241T, 0243T, 0244T, 0254T, 0255T, 0262T, 0263T, 0264T, 0265T, 0266T, 0267T, 0268T, 0269T, 0270T, 0271T, 0272T, 0273T, 0274T, 0278T, 0281T, 0286T, 0287T, 0288T, 0289T, 0290T, 0291T, 0292T, 0293T, 0294T, 0299T, 0300T, 0301T, 0302T, 0303T, 0304T, 0305T, 0306T, 0307T, 0309T, 0310T, 0311T, 0312T, 0313T, 0314T, 0315T, 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, 0387T, 0388T, 0389T, 0390T, 0391T
L33682 Circulating Tumor Cell Marker Assays 12/13/13 86152, 86153
L33520 CT Colonography (Virtual Colonoscopy) 12/13/13 74261, 74262, 74263, 76263
L33522 Echocardiography, Transthoracic and Transesophageal 12/13/13 76999, 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93320, 93321, 93325, A9700
L33524 Endoscopic Treatment of GERD 06/12/15 43257, 43499, 43999
L33527 Free Prostate Specific Antigen (PSA) Test 12/13/13 84154
L33528 Frequency of HbA1c Testing Greater Than Every Three Months 06/12/15 83036
L35134 Implantable Infusion Pump for Treatment of Chronic Intractable Pain 09/01/16 19105, 20982, 20999, 32999, 47370, 47371, 47380, 47381, 49203-49205, 50250, 50542, 50592, 50593, 76940, 77013, 77022, 0071T, 0072T
L33530 In Vitro Chemosensitivity & Chemoresistance Assays 06/12/15 84999, 89240
L34240 Laparoscopic Sleeve Gastrectomy for Severe Obesity 04/30/16 43775
L33535 Magnetic Resonance Angiography (MRA) of the Head and Neck, Chest, Abdomen & Pelvis, Lower Extremities 12/13/13 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72198, 73725, 74185
L33474 Microvascular Therapy in the Treatment of Peripheral Neuropathies 06/12/15 97039, 97139
L34325 Nervous System Studies Autonomic Function, Nerve Conduction and Electromyography 05/31/16 95860, 95861, 95863, 95864, 95867, 95868, 95869, 95870, 95872, 95885, 95886, 95887, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95921, 95922, 95923, 95924, 95925, 95926, 95927, 95937, 95938, 95939, 95943, 95999
L33480 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography 12/13/13 92225, 92226, 92227, 92228, 92250
L33481 Paravertebral Facet Joint Block and Facet Joint Denervation 12/13/13 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 77003, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T
L33741 Physical Medicine and Rehabilitation Policy 11/06/13 31579, 64550, 64722, 92506, 92507, 92508, 92511, 92512, 92520, 92526, 92548, 92597, 92605, 92606, 92607, 92608, 92609, 92610, 92611, 92612, 92614, 92616, 92618, 92626, 92627, 92630, 92633, 95831, 95832, 95857, 95992, 96105, 96110, 96111, 96125, 97001, 97002, 97003, 97004, 97005, 97006, 97010-97039, 97110-97546, 97597, 97598, 97602, 97605, 97606, 97750, 97755, 97760, 97761, 97762, 97799, 97810, 97811, 97813, 97814, 99212-99215, 97001-97004, G0281, G0282, G0283, G0329
L34226 Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control 06/30/16 64566
L33486 Pulse Oximetry 12/13/13 94760, 94761, 94762
L35133 Stereotactic Computer Assisted Volumetric &/or Navigational Procedure 07/31/16 20985, 61781, 61782, 61783
L33493 Symptomatic, Pathological Nail and Its Treatment 03/31/14 10060, 10061, 10140, 10160, 11720, 11721, 11730, 11732, 11740, 11750, 11752, 11755, 11760, 11762, 11765
L34161 Total Joint Arthroplasty 09/06/16 27130, 27132, 27134, 27137, 27138, 27445, 27447, 27486, 27487
L33495 Transcranial Magnetic Stimulation for Severe Depression 06/12/15 90867, 90868, 90869
L34205 Urodynamics 05/31/16 51725, 51726, 51727, 51728, 51729, 51736, 51741, 51784, 51785, 51792, 51797
L34210 Vestibular Function Testing 04/29/16 92537, 92538, 92540, 92541, 92542, 92543, 92544, 92545, 92546, 92547, 92548, 92552, 92553, 92557
L33502 Vitamin B 12 Injection 03/07/14 96372, J3420
L34207 Wireless Gastrointestinal Motility Monitoring Systems 08/17/16 91112

 

Last Updated Feb 14, 2017