J5 MAC Part A Providers serving beneficiaries in Iowa, Kansas, Missouri and Nebraska

Local Policies (LCD)

General Information

What Is a Local Coverage Determination (LCD)? adobe acrobat file
LCD Reconsideration Process

J5 MAC A Local Coverage Determinations (LCDs)

Title CMS ID# Original Effective Date Status Last Revision Date
Ablative Therapy L30312 09/15/09 Active NA
Allergy Testing and Allergy Immunotherapy L30471 02/16/10 Final NA
Application of Bioengineered Skin Substitutes L30135 08/16/09 Active 11/01/09
Bariatric Surgery L26558 02/01/08 Active 06/01/09
Bisphosphonate Drug Therapy L30139 10/16/09 Active 11/01/09
Blepharoplasty, Blepharoptosis and Brow Lift L29973 07/16/09 Active 08/01/09
Bone Mass Measurement L28527 03/18/09 Active 11/01/09
Botulinum Toxin Type A & Type B L28555 05/16/09 Active 02/01/10
Brachytherapy L30320 08/16/09 Active NA
B-type Natriuretic Peptide (BNP) Testing L26603 02/01/08 Active NA
Capsule Endoscopy L30141 12/16/09 Active NA
Cardiovascular Stress Testing L28563 02/16/09 Active 10/01/09
Cataract Surgery and Complex Cataract Surgery L30159 12/16/09 Active NA
Chemotherapy Drugs and their Adjuncts L28576 05/16/09 Active 02/01/10
Colonoscopy and Sigmoidoscopy-Diagnostic L30304 09/15/09 Active 10/01/09
Computed Coronary Tomography Angiography L30288 08/16/09 Active 01/01/10
Computerized Tomography (CAT Scans) L28544 03/25/09 Active 10/01/09
Corneal Pachymetry L30485 03/18/10 Final NA
Cranial Stereotactic Radiosurgery (SRS) and Cranial Stereotactic Radiotherapy (SRT) L30318 08/16/09 Active NA
CT Colonography (Virtual Colonoscopy [VC]) L30300 11/15/09 Active 01/01/10
Cytogenetic Studies L30487 03/18/10 Final NA
Dysphagia/Swallowing Therapy L26565 02/01/08 Active NA
Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) L29584 10/16/09 Active NA
Electromagnetic Navigation Bronchoscopy (ENB) L30510 02/15/10 Final NA
Erythropoiesis Stimulating Agents L26655 02/01/08 Active 10/01/09
Flow Cytometry L30161 11/16/09 Active 12/01/09
Free Prostate Specific Antigen (Free PSA) L26612 02/01/08 Active NA
Health and Behavior Assessment/Intervention L30514 03/18/10 Final NA
Helicobacter Pylori Testing L30163 10/16/09 Active 02/01/10
Human Granulocyte/Macrophage Colony Stimulating Factors L30306 09/15/09 Active 08/01/09
Hyperbaric Oxygen (HBO) Therapy L26567 02/01/08 Active NA
Immune Globulins L30147 11/15/09 Active NA
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L30153 10/16/09 Active NA
Interventional Cardiology L26608 02/01/08 Active 11/15/09
Intra-articular Injections of Hyaluronan L30149 10/16/09 Active 01/01/10
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs L30479 03/18/10 Final NA
Magnetic Resonance Imaging L28723 03/25/09 Active 10/01/09
Medicare Part B Coverage of Services and Procedures in Nursing Facilities L26570 02/01/08 Active NA
Mini Mental Status Examination (MMSE) L26571 02/01/08 Active NA
Moderate (Conscious) Sedation L29582 07/16/09 Active 08/01/09
Mohs' Micrographic Surgery L26572 02/01/08 Active 08/01/09
Noninvasive Vascular Testing (N.I.V.T.) L28586 05/18/09 Active 10/01/09
Optical Coherence Tomography (OCT) L29971 10/16/09 Active 10/01/09
Optometrist Services L30157 01/16/10 Active NA
Outpatient Hospital Psychiatric Services L26575 02/01/08 Active 08/08/09
Outpatient Intermittent Intravenous Positive Inotropic Therapy: Milrinone Iactacte (Primacor) and Dobutamine hydrochloride (Dobutrex) for Treatment of Heart Failure L26576 02/01/08 Active NA
Paravertebral Facet Joint Block and Facet Joint Denervation L30483 03/18/10 Final NA
Percutaneous Coronary Interventions (PCI) L28478 02/16/09 Active 08/01/09
Polysomnography Sleep Testing L26556 02/01/08 Active 01/01/10
Posterior Tibial Nerve Stimulation PTNS L28457 02/16/09 Active 08/01/09
Psychiatry and Psychological Services L30489 03/18/10 Final NA
Psychiatric Inpatient Hospitalization L30441 03/18/10 Final NA
Psychiatric Partial Hospitalization Program (PHP) L26611 02/01/08 Active 06/16/09
Psychological and Neuropsychological Testing L26581 02/01/08 Active NA
Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) L30316 08/16/09 Active NA
Removal of Benign Skin Lesions L30330 08/16/09 Active 11/01/09
Routine Foot Care And Debridement Of Nails L30322 08/16/09 Active 01/01/10
Selective Internal Radiation Therapy (SIRT) for Primary and Secondary Hepatic Malignancy (90YMicrosphere Hepatic Brachytherapy) L30137 10/16/09 Active NA
Stereotactic Computer Assisted Volumetric and/or Navigational Procedure L29586 08/16/09 Active NA
Thrombopoietic Growth factor - Oprelvekin L30151 11/15/09 Active 02/01/10
Transesophageal Echocardiography (Including Intraoperative TEE) L28574 03/18/09 Active 10/01/09
Transthoracic Echocardiography (TTE) L28565 03/25/09 Active 10/01/09
Treatment of Varicose Veins of the Lower Extremities L30143 11/15/09 Active 01/01/10
Trigger Points, Local Injections L30155 10/16/09 Active NA
Vitamin B 12 Injections L30145 09/15/09 Active 02/01/10
Wound Care L28572 09/15/09 Active 10/01/09

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Page Last Updated: Thursday, 28-Jan-2010 14:29:17 CST