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
L34242 Chiropractic Services 12/31/19 98940, 98941, 98942
L35008 Non-Covered Services 06/30/20 22857, 22862, 28446, 43257, 43284, 43285, 46707, 62263, 62264, 62287, 83987, 84431, 86305, 91132, 91133, 92145, 93050, 93702, 97026, 97033, 97545, 97546, 99605, 99606, 99607, J2010, J7330, 0042T, 0054T, 0055T, 0071T, 0072T, 0098T, 0100T, 0101T, 0102T, 0106T, 0107T, 0108T, 0109T, 0110T, 0111T, 0126T, 0163T, 0165T, 0174T, 0175T, 0198T, 0202T, 0205T, 0206T, 0207T, 0208T, 0209T, 0210T, 0211T, 0212T, 0219T, 0220T, 0221T, 0222T, 0232T, 0234T, 0235T, 0236T, 0237T, 0238T, 0253T, 0263T, 0264T, 0265T, 0266T, 0267T, 0268T, 0272T, 0273T, 0274T, 0278T, 0290T, 0300T, 0312T, 0313T, 0316T, 0317T, 0329T, 0330T, 0331T, 0332T, 0333T, 0335T, 0338T, 0339T, 0340T, 0341T, 0342T, 0347T, 0348T, 0349T, 0350T, 0351T, 0352T, 0353T, 0354T, 0355T, 0356T, 0357T, 0358T, 0361T, 0373T, 0374T, 0375T, 0376T, 0378T, 0379T, 0380T, 0381T, 0382T, 0383T, 0384T, 0385T, 0386T, 0396T, 0397T, 0398T, 0399T, 0400T, 0401T, 0403T, 0405T, 0408T, 0409T, 0410T, 0411T, 0412T, 0413T, 0414T, 0415T, 0416T, 0417T, 0418T, 0419T, 0420T, 0421T, 0422T, 0423T, 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, 0437T, 0439T, 0440T, 0441T, 0442T, 0443T, 0444T, 0445T, 0446T, 0447T, 0448T, 0450T, 0451T, 0452T, 0453T, 0454T, 0455T, 0456T, 0457T, 0458T, 0459T, 0460T, 0461T, 0462T, 0463T, 0464T, 0465T, 0466T, 0467T, 0468T

Last Updated Tue, 07 Jul 2020 13:28:57 +0000