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

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

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 Title LCD Number Billing and Coding Companion Article CPT / HCPCS Codes Referenced
B-type Natriuretic Peptide (BNP) Testing L34038 A57084 83880
Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs) L33979* A57162 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17110, 17111
Blepharoplasty Eyelid Surgery, and Brow Lift L36286 A57191 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909,
Botulinum Toxin Types A and B L35172 A57186 J0585, J0586, J0587, J0588, 31513, 31570, 43201, 43236, 43499, 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64640, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 64999, 67345, 95873, 95874
Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography L36889 A57184 93015, 93016, 93017, 93018, 93320, 93321, 93325, 93350, 93351, 93352, J0153, J0395, J1245, J1250, J3490
Cataract Surgery in Adults L37027 A57196 66830, 66840, 66850, 66852, 66920, 66940, 66982, 66983, 66984
Chest X-Ray Policy L37549 A57498 71045, 71046, 71047, 71048
Colon Capsule Endoscopy L38826 A58438 0355T
Computed Tomography Cerebral Perfusion Analysis (CTP) L38700 A58225 0042T
Diagnostic and Therapeutic Colonoscopy LCD L36868 A57343 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
Electrocardiograms L37283 A57327 93000, 93005, 93010, 93040, 93041, 93042
Facet Joint Interventions for Pain Management L38803 A58405 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 64999, 0213T. 0214T, 0215T, 0216T, 0217T, 0218T, 0219T, 0220T, 0221T, 0222T
Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) L37368 A56711 87505, 87506, 87507, 0097U
Frequency of Hemodialysis L37504 A55676 90999
GlycoMark Testing for Glycemic Control L36866
A57238
84378, 84999
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea L38312 A57949 0466T, 0467T, 0468T, 64568
Immune Globulin Intravenous (IVIg) L34074 A57194 J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
Implantable Continuous Glucose Monitor (I-CGM) L38659 A58138 0446T, 0447T, 0448T
In Vitro Chemosensitivity & Chemoresistance Assays L37630 A56073 84999, 89240
Injections – Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L34076 A57201 20526, 20527, 20550, 20551, 20612, 26341, 28899, 64455, 64632
Lab: Bladder/Urothelial Tumor Markers L36680 A55029 86294, 86316, 86386, 88120, 88121
Lab: Coenzyme Q10 (CoQ10) L37068 A55770 82542
Lab: Controlled Substance Monitoring and Drugs of Abuse Testing L36707 A55030 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659
Lab: Flow Cytometry L36094 A57690 88182, 88184, 88185, 88187, 88188, 88189, 86355, 86356, 86357, 86359, 86360, 86361, 86367
Lab: Special Histochemical Stains and Immunohistochemical Stains L36353 A57614 88312, 88313, 88341, 88342, 88344, 88360, 88361
Lumbar Epidural Injections L34980 A57203 62322, 62323, 62326, 62327, 64483, 64484
Lumbar MRI L37281 A57207 72148, 72149, 72158, A9585, Q9953
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor L37738 A57513 0398T
MDS FISH L37622 A57662 88271, 88273, 88274, 88275, 88291
Measurement of Salivary Hormones L36857 A57613 84999
Micro-Invasive Glaucoma Surgery (MIGS) L38301 A57864 0191T, 0449T, 0376T, 0450T, 0474T
Mohs Micrographic Surgery L35704 A56515 17311, 17312, 17313, 17314, 17315, 88302, 88304, 88305, 88307, 88309, 88314, 88331, 88332
MolDX: 4Kscore Assay L37122 A57337 81539
MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts L38380 A57233 81479
MolDX: APC and MUTYH Gene Testing L36884 A57353 81201, 81202, 81203, 81401, 81403, 81406, 81435, 81436, 81479
MolDX: BDX-XL2 L37062 A57357 0080U
MolDX: Biomarkers in Cardiovascular Risk Assessment L36362 A57055 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
MolDX: Blood Product Molecular Antigen Typing L38333 A57376 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81403, 0001U, 0084U, 0180U, 0181U, 0182U, 0183U, 0814U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0221U, 0222U
MolDX: BRCA1 and BRCA2 Genetic Testing L36163 A57355 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433, 81445, 81455, 81479, 0102U, 0103U, 0129U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U
MolDX: Breast Cancer Assay: Prosigna L36386 A57364 81520
MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test L37824 A57774 81518
MolDX: ConfirmMDx Epigenetic Molecular Assay L36329 A57606 81551
MolDX: Corus® CAD Assay L37675 A57416 81493
MolDX: Cystatin C Measurement L37618 A57644 82610
MolDX: Decision Dx-UM (Uveal Melanoma) L37072 A57622 81552
MolDX: EndoPredict® Breast Cancer Gene Expression Test L37311 A57608 81599
MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test L37891 A57420 81479
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease L36186 A57422 81206, 81207, 81208, 81219, 81270, 81402, 81403, 81445, 81450, 81455, 81479
MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR L36159 A57424 81240, 81241, 81291
MolDX: Genetic Testing for Lynch Syndrome L36374 A54996 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81317, 81318, 81319, 81403, 81432, 81433, 81435, 81436, 81445, 81455, 81479, 88341, 88342, 0101U, 0130U, 0134U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy L36544 A57465 81383
MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer L37899 A57665 81479
MolDX: Melanoma risk Stratification Molecular Testing L37748 A57290 81599
MolDX: MGMT Promoter Methylation Analysis L36192 A57433 81287
MolDX: Molecular Diagnostic Tests (MDT) L36256* A57527 0001U, 0002M, 0002U, 0003M, 0003U, 0004M, 0005U, 0006M, 0006U, 0007M, 0007U, 0008M, 0008U, 0009M, 0009U, 0010U, 0011M, 0011U, 0012M, 0012U, 0013M, 0013U, 0014U, 0016U, 0017M, 0017U, 0018U, 0019U, 0021U, 0022U, 0023U, 0024U, 0025U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0035U, 0036U, 0037U, 0038U, 0039U, 0040U, 0041U, 0042U, 0043U, 0044U, 0070U, 0084U, 0085U, 0086U, 0087U, 0088U, 0089U, 0090U, 0091U, 0092U, 0093U, 0094U, 0095U, 0096U, 0097U, 0098U, 0099U, 0100U, 0101U, 0102U, 0103U, 0104U, 0242U, 0244U, 0245U, 0246U, 81105, 81106, 81107, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81161, 81162, 81163, 81164, 81166, 81167, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81200, 81201, 81202, 81203, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81235, 81235, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81245, 81246, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81261, 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81269, 81270, 81271, 81272, 81273, 81274, 81275, 81276, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81305, 81306, 81310, 81311, 81312, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81407, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81435, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81445, 81448, 81450, 81455, 81460, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81507, 81508, 81509, 81510, 81511, 81512, 81518, 81519, 81520, 81521, 81525, 81528, 81535, 81536, 81538, 81539, 81540, 81541, 81545, 81551, 81595, 81596, 81599, 84999, 85999, 86152, 86153, 86849, 88120, 88121, 88121, 91165
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels L37315 A57340 87631, 87632, 87633, 0098U, 0099U, 0100U, 0115U
MolDX: myPath Melanoma Assay L37881 A57627 81479, 0090U
MolDX: Next-Generation Sequencing for Solid Tumors L38121 A57905 81445, 81479
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies L38125 A57892 81450, 81479
MolDX: NRAS Genetic Testing L36339 A57487 81311, 81479
MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ L36947 A57620 0045U
MolDX: Percepta© Bronchial Genomic Classifier L36891 A57504 81479
MolDX: Pharmacogenomics Testing L38337 A57385 81220, 81225, 81226, 81227, 81231, 81232, 81283, 81306, 81335, 81350, 81355, 81371, 81373, 81379, 81406, 0030U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U
MolDX: Pigmented Lesion Assay L38153 A58053 0089U
MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer L38329 A57330 81479
MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer L38649 A58187 81401, 81403, 81404, 81445, 81479, 0016M
MolDX: Prolaris™ Prostate Cancer Genomic Assay L36350 A57511 81541
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease L37082 A57691 81541
MolDX: ProMark Risk Score L36706 A57609 81479
MolDX: Prometheus IBD sgi Diagnostic Policy L37313 A57517 81479, 82397, 83520, 86140
MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease L38341 A57236 81541, 81542
MolDX: Repeat Germline Testing L38353 A57332 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81171, 81172, 81173, 81174, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81200, 81201, 81202, 81203, 81204, 81205, 81209, 81212, 81215, 81216, 81217, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81269, 81271, 81274, 81283, 81284, 81285, 81286, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81302, 81303, 81304, 81306, 81312, 81317, 81318, 81319, 81321, 81322, 81323, 81324, 81325, 81326, 81328, 81329, 81330, 81331, 81332, 81333, 81335, 81336, 81337, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81448, 81460, 81465, 81470, 81471, 81479
MRI and CT Scans of the Head and Neck L35175 A57215 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
Nerve Blockade for Treatment of Chronic Pain and Neuropathy L35457 A52725 62281, 62320, 62321, 62324, 62325, 64402, 64405, 64408, 64410, 64415, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64451 64461, 64462, 64463, 64479, 64480, 64505, 64510, 64517, 64520, 64530, 64620, 64640, 64450, 76881, 76882, 76942, 76999, 97032, 97139, G0282, G0283
Nerve Conduction Studies and Electromyography L36526 A54992 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
Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease L38615 A58097 0501T, 0502T, 0503T, 0504T
Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) L34106 A56573 22510, 22511, 22512, 22513, 22514, 22515
Peripheral Nerve Stimulation L37360 A55531 61885, 64553, 64555, 64561, 64569, 64570, 64575, 64581, 64585, 64590, 64595, 64999
Plastic Surgery L37020 A57222 15780, 15781, 15782, 15783, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 19316, 19318, 19324, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19366, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 30400, 30410, 30420, 30430, 30435, 30450
Polysomnography and Other Sleep Studies L34040 A57698 G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder L37088 A57693 90867, 90868, 90869
Respiratory Care (Respiratory Therapy) L37293 A57225 G0237, G0238, G0239, 31502, 31720, 94002, 94003, 94004, 94010, 94011, 94012, 94013, 94060, 94070, 94150, 94200, 94250, 94375, 94400, 94450, 94617, 94618, 94621, 94640, 94642, 94660, 94662, 94664, 94667, 94668, 94669, 94726, 94727, 94728, 94729, 94750, 94772
Serum Magnesium L36700 A57198 83735
Spinal Cord Stimulators for Chronic Pain L36204 A57792 63650, 63655, 63663, 63664, 63685
Total Hip Arthroplasty L36573 A57684 27130, 27132, 27134, 27137, 27138
Total Knee Arthroplasty L36577 A57686 27445, 27447, 27486, 27487
Transurethral Waterjet Ablation of the Prostate L38707 A58229 C2596, 0421T
Treatment of Males with Low Testosterone L36569 A57616 11980, 84410, 96372, J1071, J3121, J3145, J3490
Treatment of Varicose Veins of the Lower Extremities L34010 A57707 36299, 36465, 36466, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799, 93970, 93971
Trigger Point Injections L36859 A57702 20552, 20553
Vitamin D Assay Testing L34051 A57719 82306, 82652

 

Last Updated Thu, 02 Dec 2021 20:05:59 +0000