Policy Revision(s) for Local Coverage Determinations - Effective February 14, 2025

Date Posted: February 20, 2025

The following Local Coverage Determinations (LCDs) have been revised under contract number: 02101 (AK), 03101 (AZ), 02201 (ID), 03201 (MT), 03301 (ND), 02301 (OR), 03401 (SD), 03501 (UT), 02401 (WA), and 03601 (WY).

Medicare Coverage Database Number LCD Title
L37618 Lab: Cystatin C Measurement
L37020 Plastic Surgery
L39060 Platelet Rich Plasma Injections for Non-Wound Injections
L39883 Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)
L39812 Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

Effective Date: February 14, 2025

Summary of Changes: Changed 'gender' to 'sex' throughout the LCD where applicable.

Visit the Noridian Active LCDs webpage to view the document or access it via the CMS Medicare Coverage Database (MCD).

Last Updated Feb 20 , 2025