| LCD |
Effective
Date |
Revision
Effective
Date |
Title |
CPT Codes Covered in LCD |
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L33394
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10/01/2015
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07/13/2025
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Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
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L33396
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10/01/2015
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10/24/2019
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Posterior Tibial Nerve Stimulation for Voiding Dysfunction
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L33398
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10/01/2015
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07/24/2025
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Transcranial Magnetic Stimulation
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L33399
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10/01/2015
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01/01/2020
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EEG – Ambulatory Monitoring
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L33557
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10/01/2015
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10/01/2019
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Cardiac Catheterization and Coronary Angiography
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L33558
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10/01/2015
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09/19/2019
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Cataract Extraction
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L33559
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10/01/2015
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04/01/2022
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Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
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L33560
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10/01/2015
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01/01/2021
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Cardiovascular Nuclear Medicine
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L33563
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10/01/2015
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09/12/2019
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Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures
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L33567
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10/01/2015
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10/01/2019
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Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
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L33569
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10/01/2015
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12/01/2020
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Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
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L33573
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10/01/2015
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11/07/2019
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B-type Natriuretic Peptide (BNP) Testing
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L33574
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10/01/2015
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09/19/2019
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Visual Fields Testing
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L33575
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10/01/2015
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11/21/2019
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Varicose Veins of the Lower Extremity, Treatment of
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L33576
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10/01/2015
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10/24/2019
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Urodynamics
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L33577
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10/01/2015
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10/01/2019
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Transthoracic Echocardiography (TTE)
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L33578
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10/01/2015
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10/10/2019
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Transrectal Ultrasound
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L33579
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10/01/2015
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11/24/2024
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Transesophageal Echocardiography (TEE)
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L33580
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10/01/2015
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12/19/2019
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Speech-Language Pathology
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L33585
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10/01/2015
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10/24/2019
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Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
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L33591
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10/01/2015
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11/07/2019
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RAST Type Tests
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L33614
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10/01/2015
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11/07/2019
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Debridement Services
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L33616
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10/01/2015
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11/21/2019
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Osteopathic Manipulative Treatment
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L33619
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10/01/2015
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10/01/2019
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Nonvascular Extremity Ultrasound
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L33621
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10/01/2015
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09/19/2019
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Ophthalmic Biometry for Intraocular Lens Power Calculation
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L33622
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10/01/2015
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04/01/2024
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Pain Management - Injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels
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L33623
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10/01/2015
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11/07/2019
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Percutaneous Coronary Intervention
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L33624
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10/01/2015
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11/14/2019
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Psychiatric Inpatient Hospitalization
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L33626
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10/01/2015
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01/01/2024
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Psychiatric Partial Hospitalization Programs
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L33627
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10/01/2015
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10/01/2019
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Non-Invasive Vascular Studies
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L33628
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10/01/2015
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09/19/2019
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Panretinal (Scatter) Laser Photocoagulation
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L33630
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10/01/2015
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09/12/2019
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Corneal Pachymetry
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L33631
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10/01/2015
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01/01/2020
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Outpatient Physical and Occupational Therapy Services
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L33632
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10/01/2015
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01/01/2024
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Psychiatry and Psychology Services
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L33633
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10/01/2015
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10/01/2019
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Magnetic Resonance Angiography (MRA)
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L33636
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10/01/2015
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08/18/2022
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Routine Foot Care and Debridement of Nails
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L33646
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10/01/2015
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05/01/2021
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Botulinum Toxins
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L34380
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10/01/2015
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09/19/2019
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Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
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L35000
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10/01/2015
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07/13/2025
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Molecular Pathology Procedures
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L35001
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10/01/2015
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02/01/2024
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Reduction Mammaplasty
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L35028
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10/01/2015
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11/14/2019
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Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency
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L35074
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10/01/2015
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04/15/2021
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Heavy Metal Testing
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L35075
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10/01/2015
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11/07/2019
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Proton Beam Therapy
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L35076
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10/01/2015
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04/01/2020
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Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
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L35080
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10/01/2015
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02/10/2022
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Select Minimally Invasive GERD Procedures
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L35098
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10/01/2015
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11/21/2019
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Nerve Conduction Studies and Electromyography
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L35936
|
10/01/2015
|
07/17/2025
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Facet Joint Interventions for Pain Management
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L36039
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12/01/2015
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10/10/2019
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Total Joint Arthroplasty
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L36236
|
10/01/2015
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09/12/2019
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Autonomic Function Testing
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L36406
|
04/01/2016
|
10/10/2019
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Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
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L36831
|
03/16/2017
|
10/17/2019
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Visual Electrophysiology Testing
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L36850
|
05/01/2017
|
11/21/2019
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Peripheral Nerve Blocks
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L37244
|
12/01/2017
|
11/17/2024
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Micro-Invasive Glaucoma Surgery (MIGS)
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L37421
|
04/01/2018
|
08/17/2025
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Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
|
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L37475
|
03/01/2019
|
10/01/2019
|
Frequency of Hemodialysis
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L37535
|
04/01/2018
|
10/01/2021
|
Vitamin D Assay Testing
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L37606
|
08/01/2018
|
07/13/2025
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Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases
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L37810
|
04/01/2019
|
04/01/2022
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Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms
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L38014
|
08/01/2019
|
09/19/2019
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Corneal Hysteresis
|
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L38367
|
04/01/2020
|
09/07/2025
|
Fluid Jet System Treatment for LUTS/BPH
|
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L38371
|
07/01/2020
|
07/01/2020
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Multimarker Serum Tests Related to Ovarian Cancer Testing
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L38387
|
04/01/2020
|
04/01/2020
|
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
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L38571
|
04/15/2021
|
02/15/2022
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Colon Capsule Endoscopy (CCE)
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L38623
|
12/01/2020
|
06/12/2025
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Implantable Continuous Glucose Monitors (I-CGM)
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L38667
|
11/01/2020
|
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Computed Tomography Cerebral Perfusion Analysis (CTP)
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L38937
|
08/01/2021
|
02/10/2022
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Platelet Rich Plasma
|
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L38968
|
12/01/2021
|
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Thyroid Nodule Molecular Testing
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L39027
|
12/01/2021
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Respiratory Pathogen Panel Testing
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L39036
|
12/05/2021
|
11/23/2023
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Epidural Steroid Injections for Pain Management
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L39075
|
04/01/2022
|
04/01/2023
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Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
|
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L39139
|
12/24/2023
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Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
|
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L39189
|
08/01/2022
|
12/15/2024
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Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)
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L39226
|
08/01/2022
|
06/12/2025
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Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)
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L39297
|
11/01/2022
|
09/07/2025
|
Off-label Use of Rituximab and Rituximab Biosimilars
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L39314
|
11/01/2022
|
09/07/2025
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Off-Label Use of Intravenous Immune Globulin (IVIG)
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L39455
|
03/19/2023
|
08/10/2023
|
Sacroiliac Joint Injections and Procedures
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L39513
|
08/01/2023
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Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin
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L39611
|
12/24/2023
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Urine Drug Testing
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L39662
|
04/01/2024
|
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Trigger Point Injections (TPI)
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L39726
|
08/01/2024
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KidneyIntelX and KidneyIntelX.dkd Testing
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L39770
|
08/01/2024
|
01/30/2025
|
Cervical Fusion
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L39828
|
01/01/2026
|
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Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers
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L39863
|
11/24/2024
|
02/14/2025
|
Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)
|
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L39995
|
07/13/2025
|
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Pharmacogenomic Testing
|
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L40048
|
10/26/2025
|
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Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
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