Retired LCDs

Retired Local Coverage Determinations (LCDs) are available on the CMS Medicare Coverage Database (MCD). LCDs move to the MCD Archive one year after their retirement.

Retired Within One Year Archived More Than One Year Ago
Alaska - Contractor ID 02102 Alaska - Contractor ID 02102
Arizona - Contractor ID 03102 Arizona - Contractor ID 03102
Idaho - Contractor 02202 Idaho - Contractor ID 02202
Montana - Contractor ID 03202 Montana - Contractor ID 03202
North Dakota - Contractor ID 03302 North Dakota - Contractor ID 03302
Oregon - Contractor ID 02302 Oregon - Contractor ID 02302
South Dakota - Contractor ID 03402 South Dakota - Contractor ID 03402
Utah - Contractor ID 03502 Utah - Contractor ID 03502
Washington - Contractor ID 02402 Washington - Contractor ID 02402
Wyoming - Contractor ID 03602 Wyoming - Contractor ID 03602

 

Below is a listing of the Retired LCDs. NOTE: All LCDs for JF states are the same.

If an LCD contains "Coding Guidelines," they are indicated by an asterisk (*) after the MCD 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.
Medicare Database Number LCD Title Retirement Date CPT / HCPCS Codes Referenced
L24273 Application of Bioengineered Skin Substitutes: Ulcers (of Lower Extremities)   15002, 15003, 15004, 15005, 15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, 97602, Q4100, Q4101, Q4102, Q4104, Q4105, Q4106, Q4107, Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4116, Q4117, Q4118, Q4119, Q4120, Q4121, Q4122, Q4123, Q4124, Q4125, Q4126, Q4127, Q4128, Q4129, Q4130, Q4131, Q4132, Q4133, Q4134, Q4135, Q4136
L24274 * Artificial Disc   22856, 22857, 22861, 22862, 22864, 0092T, 0098T, 0163T, 0165T
L24278 Blocks and Destruction of Somatic and Sympathetic Nerves   64400, 64402, 64405, 64408, 64410, 64412, 64413, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64479, 64480, 64483, 64484, 64505, 64508, 64510, 64517, 64520, 64530, 64600, 64605, 64610, 64612, 64613, 64620, 64630, 64640, 64680, 77003
L34065 Brachytherapy: Non-intracoronary 04/01/16 19296, 19297, 19298, 20555, 31643, 41019, 43241, 55860, 55920, 57155, 57156, 58346, 58999, 76000, 76001, 76873, 76965, 77261, 77262, 77263, 77280, 72285, 77290, 77295, 77300,77316, 77317, 77318,  77332, 77333, 77334, 77336, 77370,  77470, 77750, 77761, 77762, 77763, 77767, 77768, 77770, 77771, 77772, 7777877789, 77790, 77799, 0182T, Q3001, 0395T, 0394T
L34052 Chest X-Ray 6/21/18 71045, 71046, 71047, 71048
L34067 Cytogenetic Studies 10/01/15 88120, 88121, 88230, 88233, 88235, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291, 88299, 88365, 88367, 88368
L34107* Erythropoietin Stimulating Agents (ESA) 01/01/18 J0881, Q4081
L34157 Laparoscopic Sleeve Gastrectomy 04/30/16 43775
L36542 MolDX: Chromosome 1p/19q Deletion Analysis 01/01/18 81402, 88367, 88368, 88369, 88373
L34100 Monitored Anesthesia Care (MAC) 04/09/18 00100, 00124, 00148, 00160, 00164, 00300, 00400, 00410, 00520, 00522, 00524, 00530, 00532, 00702, 00731, 00811, 00813, 00920, 01420, 01730, 01780, 01916, 01920, 01922, 01935, 01936, 01999, 99151,99152, 99153, 99155, 99156, 99157, G0500
L33188 Nerve Blockade: Somatic, Selective Nerve Root Block, and Epidural 08/07/14 62281, 62282, 62310, 62311, 62318, 62319, 64400, 64402, 64405, 64408, 64410, 64412, 64413, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64435. 64445, 64446, 64447, 64448, 64449, 64450, 64455, 64505, 64508, 64510, 64517, 64520, 64530, 64620, 64632, 64640
L30807 Paravertebral Facet Joint Nerve Block   64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636
L24354 * Radiation Oncology: External Beam/Teletherapy 5/15/14 77261, 77262, 77263, 77280, 77285, 77290, 77295, 77299, 77300, 77305, 77310, 77315, 77321, 77331, 77332, 77333, 77334, 77336, 77370, 77399, 77401, 77402, 77403, 77404, 77406, 77407, 77408, 77409, 77411, 77412, 77413, 77414, 77416, 77417, 77421, 77427, 77431, 77470, 77499, 77520, 77522, 77523, 77525
L24356 * Routine Foot Care 3/31/14 11055, 11056, 11057, 11719, 11720, 11721, G0127
L24366 Symptomatic, Pathological Nail and Its Treatment 3/31/14 10060, 10061, 10140, 10160, 11055, 11056, 11057, 11719, 11720, 11721, 11730, 11732, 11740, 11750, 11752, 11755, 11760, 11762, 11765, G0127
L34068 Urinalysis Policy 05/13/16 81000, 81001, 81002, 81003, 81005, 81007, 81015, 81020

 

Last Updated Aug 30, 2018