LCD Number Crosswalk

The LCD numbers are available to assist providers in locating the applicable policy based on the date of service.

ICD-10 ICD-9 LCD Title
L34057 L351203 B-type Natriuretic Peptide (BNP) Testing
L36281 L35534 Blepharoplasty, Eyelid Surgery, and Brow Lift
L34097 L24415 Chest X-Ray Policy
L35096 L32533 Circulating Tumor Cell Marker Assays
L34202 L26381 Erythropoiesis Stimulating Agents (ESAs)
L35178 L34127 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
L36093 L35221 Flow Cytometry
L34092 L24421 Immune Globulin Intravenous (IVIg)
L34251 L31415 Intensity Modulated Radiation Therapy (IMRT)
L34166 L32868 Laparoscopic Sleeve Gastrectomy
L34983 L34117 Lumbar Epidural Injections
L35703 L35358 Mohs Micrographic Surgery
L36321 L35508 MolDX: Breast Cancer Index Genetic Assay
L36328 L35848 MolDX: ConfirmMDx Epigenetic Molecular Assay
L36311 N/A MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
L36344 N/A MolDX: Decipher® Prostate Cancer Classifier Assay
L36324 L35524 MolDX: GeneSight® Assay for Refractory Depression
L36255 N/A MolDX: Molecular Diagnostic Tests (MDT)
L36349 N/A MolDX: Prolaris™ Prostate Cancer Genomic Assay
L35177 L28669 MRI and CT Scans of the Head, Brain, and Neck
L34137 L24690 Multidetector Computed Tomography of the Heart and Great Vessels
L35458 L34775 Nerve Blockade for Treatment of Chronic Pain and Neuropathy
L34886 L27445 Non-Covered Services
L34168 L32032 Percutaneous Vertebral Augmentation
L34059 L24422 Serum Magnesium
L36352 N/A Special Histochemical Stains and Immunohistochemical Stains
L34136 L32263 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
L36107 L35461 Treatment of Ulcers & Symptomatic Hyperkeratoses
L34060 L24431 Urinalysis Policy
L34094 L31377 Vitamin D Assay Testing


Last Updated Dec 09 , 2023