Date Posted: October 8, 2026

This Local Coverage Determination (LCD) has 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).

Effective Date: October 8, 2026

Summary of Changes:

Updated link to Bibliography #40 reference.

Visit the Noridian Active LCDs webpage to view the Active LCD or access it via the CMS MCD.