Medicare Coverage Database (MCD)

The official LCD version is in CMS Medicare Coverage Database This link will take you to an external website..

Last Updated Sep 13, 2016

Active LCDs

All LCDS are the same for each state within a Jurisdiction. A PDF of each LCD is provided on this page. An HTML version is available in the CMS Medicare Coverage Database. 

View the ICD-9 to ICD-10 LCD number crosswalk.

The Coding Guidelines are indicated by an asterisk (*) after the LCD Number.

In the table below, select an "LCD Title" link to view the locally hosted Noridian LCD PDF.

Once you access the LCD, the "Coding Guidelines" can be found under the heading, "LCD Attachments" near the end of the document. Note: All CPT/HCPCS codes listed are mentioned in the LCD, but are not necessarily subject to diagnosis codes or coverage criteria.

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LCD Number LCD Title CPT / HCPCS Codes Referenced
L33979 Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) [PDF] 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11401, 11406, 11420, 11421, 11422, 11423, 11424, 11440, 11441, 11442, 11443, 11444, 11446, 17110, 17111
L36680 Bladder/Urothelial Tumor Markers [PDF] 86294, 86316, 86386, 88120, 88121
L36286 Blepharoplasty Eyelid Surgery, and Brow Lift [PDF] 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909
L35172 Botulinum Toxin Types A and B [PDF] J0585, J0586, J0587, J0588, 31513, 31570, 31599, 43499, 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64640, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 64999, 67345, 95873, 95874
L34057 B-type Natriuretic Peptide (BNP) Testing [PDF] 83880
L36889 Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography [PDF] 93015, 93016, 93017, 93018, 93320, 93321, 93325, 93350, 93351, 93352, J0153, J0395, J1245, J1250, J3490
L34097 Chest X-Ray Policy [PDF] 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, 71035
L34066 Circulating Tumor Cell Marker Assays [PDF] 86152, 86153
L36707 Controlled Substance Monitoring and Drugs of Abuse Testing [PDF] 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659
L36868 Diagnostic and Therapeutic Colonoscopy [PDF] 44388,44389,44390, 44391, 44392, 44394, 44401, 44402, 44404, 44405, 44406, 44407, 45378, 45379, 45380, 45381, 45382, 45384, 45385, 45386, 45388, 45389, 45391, 45392, 45393
L34202* Erythropoiesis Stimulating Agents (ESAs) [PDF] J0881, J0885
L34995 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy [PDF] 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T
L36094 Flow Cytometry [PDF] 88182, 88184, 88185, 88187, 88188, 88189, 86355, 86356, 86357, 86359, 86360, 86361, 86367
L36866 GlycoMark Testing for Glycemic Control [PDF] 84378
L34076 Injections – Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma [PDF] 20526, 20550, 20551, 20612, 64455, 64632
L34080 Intensity Modulated Radiation Therapy (IMRT) [PDF] 77301, 77338
L34074 Intravenous Immune Globulin (IVIg) [PDF] J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
L34980 Lumbar Epidural Injections [PDF] 62311, 62319, 64483, 64484
L35704 Mohs Micrographic Surgery [PDF] 17311, 17312, 17313, 17314, 17315
L36884 MolDX: APC and MUTYH Gene Testing [PDF] 81201, 81202, 81203, 81403, 81406, 81435, 81479
L36362 MolDX: Biomarkers in Cardiovascular Risk Assessment [PDF] 82172, 82610, 83090, 83695, 83698, 83700,  83701, 83704, 83719, 83721, 86141
L36163 MolDX: BRCA1 and BRCA2 Genetic Testing [PDF] 81162, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81432, 81445, 81455, 81479
L36386 MolDX: Breast Cancer Assay: Prosigna [PDF] 0008M
L36316 MolDx: Breast Cancer Index Genetic Assay [PDF] 81479
L36329 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay [PDF] 81479
L36345 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay [PDF] 81479
L36368 MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay [PDF] 81479
L36198 MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing [PDF] 81445, 81455, 81479
L36891 MolDX-CDD: Percepta© Bronchial Genomic Classifier [PDF] 81479
L36350 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay [PDF] 81479
L36706 MolDX-CDD: ProMark Risk Score [PDF] 81479
L36542 MolDX: Chromosome 1p/19q Deletion Analysis [PDF] 81402, 88367, 88368, 88369, 88373
L36311 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing [PDF] 81225, 81226, 81227, 81355
L36325 MolDX: GeneSight® Assay for Refractory Depression [PDF] 81479
L36186 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease [PDF] 81206, 81207, 81208, 81219, 81270, 81402, 81403, 81445, 81450, 81455, 81479
L36159 MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR [PDF] 81240, 81241, 81291
L36374 MolDX: Genetic Testing for Lynch Syndrome [PDF] 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299,81300, 81301, 81317, 81318, 81319, 81403, 81435, 81479
L36149 MolDX: HLA-B*15:02 Genetic Testing [PDF] 81381
L36544 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy [PDF] 81383
L36192 MolDX: MGMT Promoter Methylation Analysis [PDF] 81287
L36256 MolDX: Molecular Diagnostic Tests (MDT) [PDF] 0001M, 0002M, 0003M, 0004M, 0006M, 0008M, 0009M, 81161, 81201, 81202, 81203, 81206, 81207, 81208, 81210, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81225, 81226, 81235, 81240, 81240, 81241, 81245, 81246, 81256, 81261, 81262, 81263, 81264, 81265, 81270, 81275, 81287, 81288, 81291, 81293, 81294, 81296, 81297, 81298, 81299, 81300, 81301, 81310, 81315, 81316, 81317, 81318, 81321, 81322, 81323, 81327, 81332, 81340, 81341, 81342, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81413, 81414, 81422, 81439, 81539, 81479, 81599, 84999, 85999, 86849, 87999, 88199, 88299, 88380, 88381, 88399, 89398, G0452
L36171 MolDX: Molecular RBC Phenotyping [PDF] 81403
L36339 MolDX: NRAS Genetic Testing [PDF] 81311, 81479
L36947 MolDX-CDD: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ [PDF] 81479
L35175 MRI and CT Scans of the Head, Brain, and Neck [PDF] 70336, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70540, 70542, 70543, 70551, 70552, 70553, 70557, 70558, 70559, 72125, 72126, 72127, 72141, 72142, 72156
L35457 Nerve Blockade for Treatment of Chronic Pain and Neuropathy [PDF] 97032, 97139, G0282, G0283, 76942, 76999, 76881, 76882, 64402, 64405, 64408, 64410, 64413, 64415, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64455, 64461, 64462, 64463, 64479, 64480, 64505, 64508, 64510, 64517, 64520, 64530, 64620, 64632, 64640, 62281, 62310, 62318, 77003
L36526 Nerve Conduction Studies and Electromyography [PDF] 95873, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937, 95999, G0255, 51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95874, 95885, 95886, 95887
L35008 Non-Covered Services [PDF] 22857, 22862, 28446, 32998, 34806, 43210, 43257, 46707, 62263, 62264, 62287, 83987, 84145, 84431, 86305, 91132, 91133, 92145, 93050, 93702, 93982, 97026, 97033, 97545, 97546, 99605, 99606, 99607, J2010, J7330, 0019T, 0042T, 0054T, 0055T, 0071T, 0072T, 0098T, 0100T, 0101T, 0102T, 0106T, 0107T, 0108T, 0109T, 0110T, 0111T, 0126T, 0159T, 0163T, 0165T, 0169T, 0174T, 0175T, 0190T, 0195T, 0196T, 0198T, 0202T, 0205T, 0206T, 0207T, 0208T, 0209T, 0210T, 0211T, 0212T, 0219T, 0220T, 0221T, 0222T, 0232T, 0234T, 0235T, 0236T, 0237T, 0238T, 0253T, 0254T, 0255T, 0263T, 0264T, 0265T, 0266T, 0267T, 0268T, 0272T, 0273T, 0274T, 0275T, 0278T, 0286T, 0287T, 0288T, 0289T, 0290T, 0291T, 0292T, 0293T, 0294T, 0299T, 0300T, 0301T, 0302T, 0304T, 0305T, 0306T, 0310T, 0312T, 0313T, 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, 0392T, 0393T, 0396T, 0397T, 0398T, 0399T, 0400T, 0401T, 0402T, 0403T, 0405T, 0406T, 0407T, 0408T, 0409T, 0410T, 0411T, 0412T, 0413T, 0414T, 0415T, 0416T, 0417T, 0418T, 0419T, 0420T, 0421T, 0422T, 0423T, 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, 0437T, 0438T, 0439T, 0440T, 0441T, 0442T, 0443T, 0444T, 0445T
L34106 Percutaneous Vertebral Augmentation [PDF] 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T
L34040 Polysomnography and Other Sleep Studies [PDF] G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811
L36700 Serum Magnesium [PDF] 83735
L36353 Special Histochemical Stains and Immunohistochemical Stains [PDF] 88312, 88313, 88341, 88342, 88344, 88360, 88361
L36204 Spinal Cord Stimulators for Chronic Pain [PDF] 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 95970, 95971, 95972, L8680
L34151 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) [PDF] 77371, 77372, 77373, 77432, 77435, G0339, G0340
L36573 Total Hip Arthroplasty [PDF] 27130, 27132, 27134, 27137, 27138
L36577 Total Knee Arthroplasty [PDF] 27445, 27447, 27486, 27487
L36569 Treatment of Males with Low Testosterone [PDF] 11980, 96372, J1071, J3121, J3145, J3490
L34199 Treatment of Ulcers & Symptomatic Hyperkeratoses [PDF] 10060, 10061, 11042, 11043, 11044, 11045, 11046, 11047, 11055, 11056, 11057, 97597, 97598
L36599 Treatment of Varicose Veins of the Lower Extremities [PDF] 36468, 36470, 36471, 36475, 36476, 36478, 36479, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799, 76942, 93970, 93971
L36859 Trigger Point Injections [PDF] 20552, 20553
L34051 Vitamin D Assay Testing [PDF] 82306, 82652

Last Updated Aug 10, 2017