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Access LCD or Article: Select the LCD or Article number in the table below to view the policy or article on the Medicare Coverage Database (MCD).

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Print the LCD or Article: Select the LCD or Article number in the table below to view the policy or article on the Medicare Coverage Database (MCD).

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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.

 
LCD Title LCD Number Billing and Coding Companion Article CPT / HCPCS Codes Referenced
Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin L39398 A59177 38240
Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound L39118 A58867 A2035, Q4139, Q4145, Q4155, Q4162, Q4168, Q4171, Q4174, Q4177, Q4185, Q4189, Q4192, Q4206, Q4212, Q4213, Q4215, Q4230, Q4233, Q4240, Q4241, Q4242, Q4245, Q4246, Q4310
Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) L39883 A59771 0623T, 0624T, 0625T, 0626T
B-type Natriuretic Peptide (BNP) Testing L34038 A57084 83880
BDX-XL2 L37062 A57357 0080U
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, J0589, 31513, 31570, 43201, 43236, 43499, 46505, 52287, 53899, 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, 66987, 66988
Cervical Fusion L39762 A59645 22548, 22551, 22552, 22554, 22590, 22595, 22600, 22808
Chest X-Ray Policy L37549 A57498 71045, 71046, 71047, 71048
Colon Capsule Endoscopy L38826 A58438 91113
Computed Tomography Cerebral Perfusion Analysis (CTP) L38700 A58225 0042T
Diagnostic and Therapeutic Colonoscopy L36868 A57343 44388, 44389, 44390, 44391, 44392, 44394, 44401, 44402, 44404, 44405, 44406, 44407, 45378, 45379, 45380, 45381, 45382, 45384, 45385, 45386, 45388, 45389, 45390, 45391, 45392, 45393, G0105, G0121
Electrocardiograms L37283 A57327 93000, 93005, 93010, 93040, 93041, 93042
Epidural Steroid Joint Injections for Pain Management L39242 A58995 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484
Facet Joint Interventions for Pain Management L38803 A58405 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 0213T. 0214T, 0215T, 0216T, 0217T, 0218T, 0219T, 0220T, 0221T, 0222T
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 64582, 64583, 64584
Immune Globulin Intravenous (IVIg) L34074 A57194 J1459, J1554, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1576, J1599
Implantable Continuous Glucose Monitor (I-CGM) L38659 A58138 0446T, 0447T, 0448T
Injections – Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L34076 A57201 20526, 20527, 20550, 20551, 20612, 26341, 28899, 64455, 64632
Intervertebral Disc Repair L39962 A59884 0627T, 0628T, 0629T, 0630T
Intraosseous Basivertebral Nerve Ablation L39644 A59468 64628, 64629
In Vitro Chemosensitivity & Chemoresistance Assays L37630 A56073 84999, 89240, 0083U
Lab: Bladder/Urothelial Tumor Markers L36680 A55029 86294, 86316, 86386, 88120, 88121
Lab: Coenzyme Q10 (CoQ10) L37068 A55770 82542
Lab: Cystatin C Measurement L37618 A57644 82610
Lab: Flow Cytometry L36094 A57690 88182, 88184, 88185, 88187, 88188, 88189, 86053, 86355, 86356, 86357, 86359, 86360, 86361, 86363, 86367
Lab: Special Histochemical Stains and Immunohistochemical Stains L36353 A57614 88312, 88313, 88341, 88342, 88344, 88360, 88361
Lumbar MRI L37281 A57207 72148, 72149, 72158, A9585, Q9953
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor L37738 A57513 61715
MDS FISH L37622 A57662 88271, 88273, 88274, 88275, 88291
Measurement of Salivary Hormones L36857 A57613 84999
Micro-Invasive Glaucoma Surgery (MIGS) L38301 A57864 66183, 66989, 66991, 0253T, 0449T, 0450T, 0474T
Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) L39812 A59697 27278, 27279
Mohs Micrographic Surgery L35704 A56515 17311, 17312, 17313, 17314, 17315, 88302, 88304, 88305, 88307, 88309, 88314, 88331, 88332
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, 62324, 62325, 64405, 64408, 64415, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64451, 64461, 64462, 64463, 64505, 64510, 64517, 64520, 64530, 64620, 64640, 64999, 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 75580
Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) L34106 A56573 22510, 22511, 22512, 22513, 22514, 22515
Peripheral Nerve Stimulation L37360 A55531 64553, 64555, 64561, 64569, 64570, 64575, 64581, 64585, 64590, 64595, 64596, 64597, 64598, 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, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 30400, 30410, 30420, 30430, 30435, 30450
Platelet Rich Plasma Injections for Non-Wound Injections L39060 A58790 86965, G0460, G0465, M0076, P9020, 0232T
Polysomnography and Other Sleep Studies L34040 A57698 G0398, G0399, G0400, 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811
ProMark Risk Score L36706 A57609 81479
Respiratory Care L37293 A57225 G0237, G0238, G0239, 31502, 31720, 94002, 94003, 94004, 94010, 94011, 94012, 94013, 94060, 94070, 94150, 94200, 94375, 94450, 94617, 94618, 94619, 94621, 94640, 94642, 94660, 94662, 94664, 94667, 94668, 94669, 94680, 94681, 94690, 94726, 94727, 94728, 94729, 94772
Sacroiliac Joint Injections and Procedures L39464 A59246 20610, 20611, 20552, 27096, 64451, 64625, 77002, 77012, G0260
Serum Magnesium L36700 A57198 83735
Skin Substitutes Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers L39764 A59628 15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, A2001, A2002, A2004, A2005, A2006, A2007, A2008, A2009, A2010, A2011, A2012, A2013 A2014, A2015, A2016. A2018, A2019, A2020, A2021, A2022, A2023, A2024, A2025, A4100, C5271, C5272, C5273, C5274, C5275, C5276, C5277, C5278, C9358, C9360, C9363, C9364, Q4100, Q4101, Q4102, Q4103, Q4104, Q4105, Q4106, Q4107, Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4116, Q4117, Q4118, Q4121, Q4122, Q4123, Q4124, Q4125, Q4126, Q4127, Q4128, Q4130, Q4132, Q4133, Q4134, Q4135, Q4136, Q4137, Q4138, Q4139, Q4140, Q4141, Q4142, Q4143, Q4145, Q4146, Q4147, Q4148, Q4149, Q4150, Q4151, Q4152, Q4153, Q4154, Q4155, Q4156, Q4157, Q4158, Q4159, Q4160, Q4161, Q4162, Q4163, Q4164, Q4165, Q4166, Q4167, Q4168, Q4169, Q4170, Q4171, Q4173, Q4174, Q4175, Q4176, Q4177, Q4178, Q4179, Q4180, Q4181, Q4182, Q4183, Q4184, Q4185, Q4186, Q4187, Q4188, Q4189, Q4190, Q4191, Q4192, Q4193, Q4194, Q4195, Q4196, Q4197, Q4198, Q4199, Q4200, Q4201, Q4202, Q4203, Q4204, Q4205, Q4206, Q4208, Q4209, Q4211, Q4212, Q4213, Q4214, Q4215, Q4216, Q4217, Q4218, Q4219, Q4220, Q4221, Q4222, Q4225, Q4226, Q4227, Q4229, Q4230, Q4231, Q4232, Q4233, Q4234, Q4235, Q4236, Q4237, Q4238, Q4239, Q4240, Q4241, Q4242, Q4245, Q4246, Q4247, Q4248, Q4249, Q4250, Q4251, Q4252, Q4253, Q4254, Q4255, Q4256, Q4257, Q4258, Q4259, Q4260, Q4261, Q4262, Q4263, Q4264, Q4265, Q4266, Q4267, Q4268, Q4269, Q4270, Q4271, Q4272, Q4273, Q4274, Q4275, Q4276, Q4278, Q4279, Q4280, Q4281, Q4282, Q4283, Q4284, Q4285, Q4286, Q4287, Q4288, Q4289, Q4290, Q4291, Q4292, Q4293, Q4294, Q4295, Q4296, Q4297, Q4298, Q4299, Q4300, Q4301, Q4302, Q4303, Q4304, Q4305, Q4306, Q4307, Q4308, Q4309, Q4310
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
Transcranial Magnetic Stimulation (TMS) L37088 A57693 90867, 90868, 90869
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, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799, 93970, 93971
Trigger Point Injections L36859 A57702 20552, 20553
Urine Drug Testing L36707 A55030 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659
Vitamin D Assay Testing L34051 A57719 82306, 82652
Wound and Ulcer Care L38904 A58567 11000, 11001, 11004, 11005, 11006, 11008, 11010, 11011, 11012, 11042, 11043, 11044, 11045, 11046, 11047, 11055, 11056, 11057, 29445, 29580, 29581, 97597, 97598, 97602, 97605, 97606, 97607, 97608, 97610
Last Updated Apr 14 , 2025