Retired Local Coverage Determinations

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 This link takes you to an external website. – Contractor ID 02102 Alaska This link takes you to an external website. – Contractor ID 02102
Arizona This link takes you to an external website. – Contractor ID 03102 Arizona This link takes you to an external website. – Contractor ID 03102
Idaho This link takes you to an external website. – Contractor 02202 Idaho This link takes you to an external website. – Contractor ID 02202
Montana This link takes you to an external website. – Contractor ID 03202 Montana This link takes you to an external website. – Contractor ID 03202
North Dakota This link takes you to an external website. – Contractor ID 03302 North Dakota This link takes you to an external website. – Contractor ID 03302
Oregon This link takes you to an external website. – Contractor ID 02302 Oregon This link takes you to an external website. – Contractor ID 02302
South Dakota This link takes you to an external website. – Contractor ID 03402 South Dakota This link takes you to an external website. – Contractor ID 03402
Utah This link takes you to an external website. – Contractor ID 03502 Utah This link takes you to an external website. – Contractor ID 03502
Washington This link takes you to an external website. – Contractor ID 02402 Washington This link takes you to an external website. – Contractor ID 02402
Wyoming This link takes you to an external website. – Contractor ID 03602 Wyoming This link takes you to an external website. – 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
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
L34157 Laparoscopic Sleeve Gastrectomy 04/30/16 43775
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 Sep 13, 2017