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
L34038 L31568 B-type Natriuretic Peptide (BNP) Testing
L36286 L35536 Blepharoplasty, Eyelid Surgery, and Brow Lift
L35172 L24280 Botulinum Toxin Types A and B
L34065 L24281 Brachytherapy: Non-Intracoronary
L34052 L32844 Chest X-Ray Policy
L34009 L24288 Chiropractic Services
L34066 L32528 Circulating Tumor Cell Marker Assays
L34107 L24301 Erythropoiesis Stimulating Agents (ESAs)
L34995 L33842 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
L36094 L35208 Flow Cytometry
L34074 L32846 Immune Globulin Intravenous (IVIg)
L34076 L24317 Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
L34080 L24318 Intensity Modulated Radiation Therapy (IMRT)
L34157 L32866 Laparoscopic Sleeve Gastrectomy
L34980 L33836 Lumbar Epidural Injections
L35704 L24331 Mohs Micrographic Surgery
L36316 N/A MolDX: Breast Cancer Index Genetic Assay
L36329 L35850 MolDX: ConfirmMDx Epigenetic Molecular Assay
L36312 N/A MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
L36345 N/A MolDX: Decipher® Prostate Cancer Classifier Assay
L36325 L35504 MolDX: GeneSight® Assay for Refractory Depression
L36256 N/A MolDX: Molecular Diagnostic Tests (MDT)
L36350 N/A MolDX: Prolaris™ Prostate Cancer Genomic Assay
L34100   Monitored Anesthesia Care (MAC)
L35175 L32848 MRI and CT Scans of the Head, Brain, and Neck
L35457 L34779 Nerve Blockade for Treatment of Chronic Pain and Neuropathy
L35008 L24473 Non-Covered Services
L34106 L24383 Percutaneous Vertebral Augmentation
L34040 L24350 Polysomnography and Other Sleep Studies
L34072 L24359 Sensory Evoked Potentials & Intraoperative Neurophysiology Monitoring
L33979 L24361 Skin Lesion Removal (Excludes Actinic Keratosis and MOHS)
L36353 N/A Special Histochemical Stains and Immunohistochemical Stains
L34151 L32234 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
L34199 L24374 Treatment of Ulcers & Symptomatic Hyperkeratoses
L34010 L24374 Treatment of Varicose Veins of the Lower Extremities
L34068 L33034 Urinalysis Policy
L34051 L32132 Vitamin D Assay Testing


Last Updated Dec 09 , 2023