Below is a list of Local Coverage Determinations (LCDs) and associated coverage articles. Search within this current listing by LCD or article number or title by using the CTRL+F function. The CMS Medicare Coverage Database: Advanced Search feature allows you to search by additional filters.

*Note: Scroll to the bottom of the Future Effective Policy under 'Associated Links' and select the previous version to see an Active Policy.

LCD Title
LCD ID #
Article Title
Article ID #
CPT/HCPCS Codes
3D Interpretation and Reporting of Imaging Studies
3D Interpretations and Reporting of Imaging Studies
76376, 76377
Allergy Skin Testing
N/A
N/A
95004, 95017, 95018, 95024
Assays for Vitamins and Metabolic Function
N/A
N/A
82180, 82306, 82379, 82607, 82652, 82746, 83090, 83698, 84207, 84252, 84425, 84446, 84590, 84591, 84597, 85385, 86141, 86352, 86353
Blepharoplasty, Eyelid Surgery, and Brow Lift
N/A
N/A
15820, 15821, 15822, 15823, 67192, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924
Brain Natriuretic Peptide (BNP) Level
N/A
N/A
83880
Cardiac Computed Tomography & Angiography (CCTA)
N/A
N/A
75571, 75572, 75573, 75574, 0501T, 0502T, 0503T, 0504T
Cardiac Radionuclide Imaging
Billing Requirements for Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
78451, 78452, 78453, 78454, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78496, A4641, A9500, A9501, A9502, A9505, A9526, A9555
Cardiac Rehabilitation
Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Supplemental Instruction Article
93797, 93798, G0422, G0423
Cataract Surgery
Complex Cataract Surgery: Appropriate Use and Documentation
66830, 66840, 66850, 66852, 66920, 66940, 66982, 66983, 66984
Chemodenervation
N/A
N/A
46505, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 64999, 67345, 95873, 95874, J0585, J0586, J0587, J0588
Chiropractic Services
N/A
N/A
98940, 98941, 98942
Colonoscopy/
Sigmoidoscopy/
Proctosigmoidoscopy
Incomplete Colonoscopy/Failed Colonoscopy

G0105, 44388, 44389, 44390, 44391, 44392, 44394, 44401, 44402,  45300, 45303, 45305, 45307, 45308, 45309, 45315, 45317, 45320, 45321, 45327, 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45340, 45341, 45342, 45346, 45347, 45349, 45378, 45379, 45380, 45380, 45381, 45381, 45382, 45382, 45384, 45384, 45385, 45385, 45386, 45388, 45389, 45390, 45391, 45392, 45393, 45398

 

 

 

 

 

 

 
 
Screening Colonoscopy Converted to a Diagnostic and/or Therapeutic Colonoscopy
 
Computerized Axial Tomography (CT), Thorax
N/A
N/A
71250, 71260, 71270
Continuous Peripheral Nerve Blocks (CPNB)
N/A
N/A
64416, 64446, 64448, 64449
Corneal Pachymetry
N/A
N/A
76514
Cosmetic and Reconstructive Surgery
Oral Maxillofacial Prosthesis
E0485, E0486, 15780, 15781, 15782, 15783, 15830, 15847, 19316, 19324, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19366, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19318, 21235, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 15730, 15733, 21076, 21077, 21079, 21080, 21081, 21082, 21083, 21084, 21086, 21087, 21088, 21089, 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21172, 21175, 21179, 21180, 21181, 21182, 21183, 21184, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21230, 21240, 21242, 21243, 21244, 21245, 21246, 21247, 21248, 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21280, 21282, 21295, 21296, 21299
CT of the Abdomen and Pelvis
N/A
N/A
72192, 72193, 72194, 74150, 74160, 74170, 74176, 74177, 74178
CT of the Head
N/A
N/A
70450, 70460, 70470
Echocardiography
N/A
N/A
93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93320, 93321, 93325, 93350, 93351, 93352, 93355, A9700, J0153, J0280, J0461, J1245, J1250
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
N/A
N/A
64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636
Frequency of Hemodialysis L34575
Coding for Hemodialysis Sessions
A55354  90999
HbA1c
N/A
N/A
83036
Health and Behavior Assessment/Intervention
N/A
N/A
96150, 96151, 96152, 96153, 96154, 96155
Hyaluronate Polymers
N/A
N/A
J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329
Implantable Infusion Pump
Implantable Infusion Pump Coding & Billing Guidelines
J2274, J2278, J7999
In Vitro Chemosensitivity & Chemoresistance Assays
N/A
N/A
84999, 89240
Infliximab
N/A
N/A
J1745, Q5103, Q5104, Q5109
Intraoperative Radiation Therapy L37779 N/A  N/A  19294, 77424, 77425, 77469, C9726
Intravenous Immunoglobulin (IVIG)
N/A
N/A
J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599, J2791, J2792
Laparoscopic Sleeve Gastrectomy for Severe Obesity
N/A
N/A
43775
Lumbar Epidural Steroid Injections
N/A
N/A
62322, 62323, 64483, 64484
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor L37761
N/A
N/A
0398T
Micro-Invasive Glaucoma Surgery (MIGS) L37531 N/A N/A 0191T, 0449T, 0376T, 0450T
Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift®)
N/A
N/A
52441, 52442, C9739, C9740, L8699
Mohs Micrographic Surgery (MMS)
N/A
N/A
17311, 17312, 17313, 17314, 17315
Nerve Blocks and Electrostimulation for Peripheral Neuropathy
N/A
N/A
64450, 97032, 97139, G0282, G0283
Nerve Conduction Studies and Electromyography
N/A
N/A
51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937, 95999, G0255
Non-Covered Category III CPT Codes
N/A
N/A
0042T, 0058T, 0071T, 0072T, 0095T, 0098T, 0101T, 0102T, 0106T, 0107T, 0108T, 0109T, 0110T, 0111T, 0126T, 0163T, 0165T, 0174T, 0175T, 0184T, 0198T, 0200T, 0201T, 0202T, 0205T, 0206T, 0207T, 0208T, 0209T, 0210T, 0211T, 0212T, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0219T, 0220T, 0221T, 0222T, 0228T, 0229T, 0230T, 0231T, 0232T, 0234T, 0235T, 0236T, 0237T, 0238T, 0253T, 0254T, 0263T, 0264T, 0265T, 0266T, 0267T, 0268T, 0269T, 0270T, 0271T, 0272T, 0273T, 0274T, 0278T, 0290T, 0312T, 0313T, 0314T, 0315T, 0316T, 0317T, 0329T, 0330T, 0331T, 0332T, 0333T, 0335T,  0338T, 0339T, 0341T, 0342T, 0347T, 0348T, 0349T, 0350T, 0351T, 0352T, 0353T, 0354T, 0355T, 0356T, 0357T, 0358T, 0362T, 0373T, 0375T, 0377T, 0380T, 0381T, 0382T, 0383T, 0384T, 0385T, 0386T, 0394T, 0395T, 0396T, 0397T, 0398T, 0399T, 0400T, 0401T, 0403T, 0404T, 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, 0449T, 0450T, 0451T, 0452T, 0453T, 0454T, 0455T, 0456T, 0457T, 0458T, 0459T, 0460T, 0461T, 0462T, 0463T, 0464T, 0465T, 0466T, 0467T, 0468T, 0469T, 0470T, 0471T, 0472T, 0473T, 0474T, 0475T, 0476T, 0477T, 0478T
Noncovered Services other than CPT® Category III Noncovered Services
N/A
N/A
01990, 15824, 15825, 15826, 15828, 15829, 15876, 15877, 15878, 15879, 17380, 19105, 20985, 21073, 21811, 22586, 22857, 22858, 22861, 22862, 22865, 28035, 28446, 28890, 29868, 32998, 41530, 43257, 46707, 53860, 58321, 58322, 58323, 58670, 58671, 58970, 58974, 58976, 59012, 62263, 62264, 62287, 64702, 64704, 64708, 64712, 64714, 64722, 64726, 64727, 65785,
76981, 76982, 76983,
82016, 82017, 82777, 83006, 83987, 84066, 84134, 84431, 86305, 86343, 87084, 88375, 89250, 89251, 89253, 89254, 89255, 89257, 89258, 89259, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89335, 89337, 89342, 89343, 89344, 89346, 89352, 89353, 89354, 89356, 90476, 90477, 90581, 90585, 90620, 90621, 90625, 90632, 90633, 90634, 90644, 90647, 90648, 90649, 90650, 90680, 90681, 90690, 90691, 90849, 91132, 91133, 92145, 92970, 92971, 92997, 92998, 93702, 94014, 94015, 94016, 97545, 97546, C1749, C1830, C9727, C9734, J2010, J3530, J7297, J7298, J7330
Nonobstetric Pelvic Ultrasound
N/A
N/A
76856, 76857
Octreotide Acetate for Injectable Suspension (Sandostatin LAR depot)
N/A
N/A
J2353
Ophthalmic Angiography (Fluorescein and Indocyanine Green)
N/A
N/A
92235, 92240, 92242
Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Coding Article for Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
92225, 92226, 92227, 92228, 92250
Polysomnography
Accreditation and Credentialing Requirements for Polysomnography LCD L36593
95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400
Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control
N/A
N/A
64566
Pulmonary Stress Testing
N/A
N/A
94617, 94618, 94621
Removal of Benign and Malignant Skin Lesions
Billing and Coding for Removal of Benign and Malignant Skin Lesions
 
11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 11600, 11601, 11602, 11603, 11604, 11606, 11620, 11621, 11622, 11623, 11624, 11626, 11640, 11641, 11642, 17000, 17003, 17004, 17110, 17111, 17260, 17261, 17262, 17263, 17264, 17266, 17270, 17271, 17272, 17273, 17274, 17276, 17280, 17281, 17282, 17283, 17284, 17286
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder
N/A
N/A
90867, 90868, 90869
Respiratory Therapy and Oximetry Services
N/A
N/A
31720, 94640, 94664, 94760, 94761, 94762
Retroperitoneal Ultrasound
Retroperitoneal Ultrasound Coding and Billing
76700, 76705, 76706, 76770, 76775, 76776
Rituximab (Rituxan®)
N/A
J9311, J9312 
Routine Foot Care
N/A
N/A
11055, 11056, 11057, 11719, 11720, 11721, G0127
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
N/A
N/A
92132, 92133, 92134
Somatosensory Testing
N/A
N/A
95925, 95926, 95927
Special Electroencephalography
N/A
N/A
95953
Spinal Cord Stimulators for Chronic Pain
N/A
N/A
63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 95970, 95971, 95972, L8680
Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication L37774  N/A 93668
Swallowing Studies for Dysphagia
N/A
N/A
70370, 70371, 74230
Total Joint Arthroplasty
N/A
N/A
27130, 27132, 27134, 27137, 27138, 27445, 27447, 27486, 27487
Trigger Point Injections
N/A
N/A
20552, 20553
Upper Gastrointestinal Endoscopy and Visualization
N/A
N/A
43191, 43192, 43193, 43194, 43195, 43196, 43197, 43198, 43200, 43201, 43202, 43204, 43205, 43206, 43210, 43211, 43212, 43213, 43214, 43215, 43216, 43217, 43220, 43226, 43227, 43229, 43231, 43232, 43233, 43235, 43236, 43237, 43238, 43239, 43240, 43241, 43242, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43252, 43253, 43254, 43255, 43257, 43259, 43260, 43261, 43262, 43263, 43264, 43265, 43266, 43270, 43274, 43275, 43276, 43277, 43278, 43284, 43285, 43499, 74235
Varicose Veins of the Lower Extremities
Billing and Coding: Varicose Veins and Lower Extremities
36465, 36466, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 37700, 37718, 37722, 37765, 37766, 37780, 37785, 37500, 37735, 37760, 37761, 93970, 93971
Vertebroplasty/Kyphoplasty
N/A
N/A
22510, 22511, 22512, 22513, 22514, 22515, 22899
Vestibular Function Testing
N/A
N/A
92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546, 92547, 92548, 92552, 92553, 92556, 92557
Virtual Colonoscopy (CT Colonography)
N/A
N/A
74261, 74262
White Cell Colony Stimulating Factors
Neulasta® (pegfilgrastim) Onpro® Kit (On-body Injector)
96372, 96377, J1442, J1447, J2505, J2820, Q5101, Q5108, Q5110, Q5111 
Wireless Capsule Endoscopy
N/A
N/A
91110, 91111
Wireless Gastrointestinal Motility Monitoring Systems
N/A
N/A
91112
YAG Capsulotomy
N/A
N/A
66821
N/A
N/A
Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications
A4641, A9699, J3490, J3590, J9999
N/A
N/A
Aflibercept (Eylea) Coding and Billing Guidelines
67028, J0178
N/A
N/A
Amniotic Membrane Billing Guidelines for HCPCS Code V2790
65775, 65778, 65779, 65780, V2790
N/A
N/A
Anesthetic 'Caine Drugs'
N/A
N/A
N/A
ArgusM II Retinal Prosthesis System
0100T
N/A
N/A
Billing and Coding for Chemotherapy A56141

A9513, J0202, J9019, J9022, J9023, J9032, J9034, J9039, J9042, J9047, J9057, J9145, J9153, J9173, J9176, J9179, J9203, J9205, J9207, J9228, J9229, J9271, J9285, J9295, J9299, J9301, J9302, J9306, J9308, J9315, J9330, J9352, J9354, J9355, J9400, Q2017, Q2049, Q2050

N/A N/A  Billing and Coding Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 A56065

J7170, J7175, J7179, J7180, J7181,  J7183, J7182, J7185, J7186, J7187, J7188, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7196, J7197, J7198, J7200, J7201, J7202, J7203, J7205, J7207, J7209, J7210, J7211

N/A
N/A
Billing and Coding Instructions for Lemtrada® (alemtuzumab) When Used in the Treatment of Relapsing Multiple Sclerosis
J0202
N/A
N/A
Billing and Coding of Drug and Biological Infusions
96360-96379, 96401-96549, G0498, J0129, J0202, J0490, J0638, J0897, J1602, J1745, J2182, J2357, J2786, J2793, J3262, J3357, J3590, J9000-J9999, J9145, J9176, J9205, J9217, J9271, J9352, J9295, Q2017, Q2050, Q5103, Q5104
N/A
N/A
Coding and Billing External Components for Cochlear Implants
L7510, L7520, L8614, L8615, L8616, L8617, L8618, L8619, L8621, L8622, L8623, L8624, L8627, L8628, L8629, L9900
N/A
N/A
Coverage for High Resolution Anoscopy
46601, 46607
N/A
N/A
CPT Modifier 59: Gastroenterology
45380, 45385
NA NA  E&M Coding for Oral Surgeons A56006 99201-99215
N/A
N/A
Endometrial Hyperplasia Treatment
58999
N/A
N/A
FDA approves Iluvien for Diabetic Macular Edema
67028, J7313
N/A
N/A
Fracture of Ribs with Internal Fixation
21811, 21812, 21813
N/A
N/A
Gender Reassignment Services for Gender Dysphoria
11950, 11951, 11952, 11954, 15775, 15776, 15820, 15821, 15822, 15823, 15824, 15825, 15826, 15828, 15829, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15876, 15877, 15878, 15879, 17380, 19303, 19304, 19316, 19325, 19350, 21120, 21121, 21122, 21123, 21125, 21127, 21208, 21209, 30400, 30410, 30420, 30430, 30435, 30450, 53420, 53425, 53430, 54660, 54125, 54520, 54690, 55175, 55180, 55866, 55970, 55980, 56625, 56800, 56805, 57106, 57110, 57291, 57292, 57295, 57296, 57335, 57426, 58150, 58180, 58260, 58262, 58275, 58290, 58291, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58720
N/A
N/A
Glaucoma Screening
G0117, G0118
N/A
N/A
Hemorrhoid Artery Ligation CPT Code 0249T Article
0249T
N/A
N/A
IDTFs and Low Dose CT Scan for Lung Cancer Screening for HCPCS Code G0297
G0296, G0297
N/A N/A Implantable Automatic Defibrillators – Coding and Billing A56343 33202, 33203, 33215, 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, G0448
N/A
N/A
Implantable Miniature Telescope (IMT) for Macular Degeneration
0308T
N/A
N/A
Low frequency, non-contact, non-thermal ultrasound (CPT code 97610)
11042, 11043, 11044, 11045, 11046, 11047, 97597, 97598, 97602, 97607, 97608, 97610
N/A
N/A
Medicare Preventive Coverage for Certain Vaccines
90630, 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90670, 90672, 90673, 90674, 90675, 90676, 90682, 90685, 90686, 90687, 90688, 90689, 90702, 90714, 90732, 90739, 90740, 90743, 90744, 90746, 90747, 90756, G0008, G0009, G0010, Q2034, Q2035, Q2036, Q2037, Q2038, Q2039
N/A
N/A
Neuromodulation for Fecal Incontinence
N/A
N/A
N/A
Once in a Lifetime Abdominal Aortic Aneurysm (AAA) Screening Article
76706
N/A
N/A
Oral Surgery and Maxillofacial Surgery Specialty Codes
N/A
N/A
N/A
Percutaneous Ventricular Assist Device
33990, 33991, 33992, 33993
N/A
N/A
Periodic Adjustment of Gastric Restrictive Device after the Global Period: Coding and Billing Instructions
43999
N/A
N/A
Pre/Postoperative Care: Date of Service
N/A
N/A
N/A
Radiology Services: Multiple, Identical Services on Same Day
73000
N/A
N/A
Repeat or Duplicate Services on the Same Day
N/A
N/A
N/A
Repeat X-ray or EKG Interpretations by Same or Different Physician
N/A
N/A
N/A
Sacroiliac-Bone Implant System
27279
N/A
N/A
Single Chamber and Dual Chamber Permanent Cardiac Pacemakers – Coding and Billing
33206, 33207, 33208
N/A
N/A
Spiracur SNaP® Wound Care System
97607, 97608
N/A
N/A
Thermal Capsulorrhaphy
29999
N/A
N/A
Videostroboscopy and Nasopharyngoscopy Procedures Performed by Speech-Language Pathologists (SLPs)
N/A
N/A
N/A
Xofigo Billing Instructions
A9606

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