2020 ICD-10 Local Coverage Determinations (LCD) and Local Coverage Article (LCA) Updates

The following LCA's have been revised under contractor numbers: 02101 (AK), 02201 (ID), 02301 (OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY). All LCD LCAs are titled with "Billing and Coding: LCD title"

Effective Date: October 1, 2020
Summary of Changes: The following LCA(s) have been updated to include and/or remove ICD-10 codes.

LCD Title LCD/LCA Number ICD-10 Added ICD-10 Deleted
Chest X-Ray L37549 / A57498

R51.0 - Headache, unspecified

R51.9 - Elevation of levels of liver transaminase levels

NOTE: These codes fall under ICD-10 that DO NOT Support Medical Necessity.

R51 - Headache

NOTE: These codes fall under ICD-10 that DO NOT Support Medical Necessity.

Diagnostic and Therapeutic Colonoscopy L36868 / A57343

K59.81 - Ogilvie Syndrome

K59.89 - Other specified functional intestinal disorders


Immune Globulin Intravenous (IVIg) L34074 / A57194

D59.11 - Warm autoimmune hemolytic anemia

D59.12 - Cold autoimmune hemolytic anemia

D59.13 - Mixed type autoimmune hemolytic anemia

D59.19 - Other autoimmune hemolytic anemia

D59.1 - Other autoimmune hemolytic anemias

Nerve Conduction Studies L36526 / A54992

G11.11 - Friedreich ataxia

G11.19 - Other early-onset cerebellar ataxia

G71.21 - Nemaline myopathy

G71.220 - X-linked myotubular myopathy

G71.228 - Other centronuclear myopathy

G71.29 - Other congenital myopathy

G11.1 - Early-onset cerebellar ataxia

G71.2 - Congenital myopathies

Respiratory Care (Respiratory Therapy) L37293 / A57225

J82.81 - Chronic eosinophilic pneumonia

J82.82 - Acute eosinophilic pneumonia

J82.83 - Eosinophilic asthma

J82.89 - Other pulmonary eosinophilia, not elsewhere classified

J84.170 - Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere

J84.178 - Other interstitial pulmonary diseases with fibrosis phenotype in diseases classified elsewhere

D57.431 - Sickle-cell thalassemia beta zero with acute chest syndrome

D57.451 - Sickle-cell thalassemia beta plus with acute chest syndrome

J82 - Pulmonary eosinophilia, not elsewhere classified

J84.17 - Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere

Routine Footcare A57957

N18.30 - Chronic kidney disease, stage 3 unspecified

N18.31 -Chronic kidney disease, stage 3

N18.32 - Chronic kidney disease, stage 3b

N18.3 - chronic kidney disease, stage 3 (moderate)

Plastic Surgery L37020 / A57222   R51 - Headache


Visit the Noridian Website to view all LCDs and LCAs or access it via the CMS MCD.


            Last Updated Fri, 25 Sep 2020 17:42:08 +0000