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Local Coverage Determinations (LCD)

General Information

CMS Internet-Only Manuals (IOMs)

LCD Reconsideration Process

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Our ICD-9 LCDs can be viewed on the Medicare Coverage Database (MCD). Use the Quick Search box to search by the ICD-9 LCD number (i.e., Document ID).

You may also link to the ICD-9 LCDs through their corresponding ICD-10 LCDs located below. Begin by opening the applicable ICD-10 LCD, then locate the LCD Information section within the policy. If a final ICD-9 LCD existed, you will see "Original ICD-9 LCD ID" with a link to the policy. Select the link to be taken to the ICD-9 LCD on the CMS website. Remember, this only applies to the ICD-10 LCDs that had a final ICD-9 policy prior to October 1, 2015.

J5 MAC B Local Coverage Determinations (LCDs)

This table is sortable by LCD Title, CMS ID#, or WPS ID #. In order to sort the table, you will need to actually select the table titles.

Title CMS ID# WPS ID# Original Effective Date Status Last Revision Date
Allergy Immunotherapy
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L36408 ALRG-005 03/18/16 Active 03/18/16
Allergy Testing
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L36402 ALRG-004 03/18/16 Active 10/01/16
Autonomic Function Testing
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35124 NEURO-015 10/01/15 Active 09/01/16
Bisphosphonate Drug Therapy
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34648 INJ-025 10/01/15 Active 10/01/15
Blepharoplasty, Blepharoptosis and Brow Lift
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34528 OPHTH-022 10/01/15 Active 10/01/15
Botulinum Toxin Type A & Type B
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34635 INJ-018 10/01/15 Active 10/01/16
Category III Codes
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35490 PHYS-084 10/01/15 Active 10/01/16
Chemotherapy Drugs and their Adjuncts
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35053 HONC-010 10/01/15 Active 10/01/16
Chiropractic Services
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34585 CHIRO-001 10/01/15 Active 10/01/16
Colonoscopy and Sigmoidoscopy-Diagnostic
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34614 GI-006 10/01/15 Active 10/01/16
Coronary Computed Tomography Angiography (CCTA)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35121 RAD-043 10/01/15 Active 10/01/16
Cosmetic and Reconstructive Surgery
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34698 GSURG-032 10/01/15 Active 10/01/16
Drug Testing
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34645 PATH-035 10/01/15 Active 08/01/16
Drugs and Biologics (Non-chemotherapy)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34741 INJ-041 10/01/15 Active 10/01/16
Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34636 CV-016 10/01/15 Active 04/01/16
Endoscopic Treatment of GERD
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34659 GI-010 10/01/15 Active 01/01/16
Erythropoiesis Stimulating Agents (ESAs)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34633 INJ-023 10/01/15 Active 09/01/16
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35996 NEURO-016 10/01/15 Active 04/01/16
Flow Cytometry
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34651 PATH-016 10/01/15 Active 10/01/16
Foot Care
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L36404 FT-002 02/16/16 Active 10/01/16
Genetic Testing for CYP2C19, CYP2D6, CYP2C9, and VKORC1
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L36398 PATH-039 04/16/16 Active NA
Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L36400 PATH-041 04/16/16 Active 04/16/16
Human Granulocyte/Macrophage Colony Stimulating Factors
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34699 INJ-019 10/01/15 Active 10/01/16
Immune Globulins
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34771 INJ-012 10/01/15 Active 10/01/16
Immunizations
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34596 ALRG-003 10/01/15 Active 05/01/16
Intra-articular Injections of Hyaluronan
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34525 INJ-033 10/01/15 Active 06/01/16
Intraoperative Neurophysiological Testing
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34623 GSURG-034 10/01/15 Active 10/01/16
Lumbar Epidural Injections
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L36521 NEURO-017 06/16/16 Active NA
Mohs Micrographic Surgery
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35494 DERM-010 10/01/15 Active 01/01/16
MolDX: Biomarkers in Cardiovascular Risk Assessment
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L36523 CV-050 06/16/16 Active 10/01/16
Molecular Diagnostic Testing
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34762 PATH-037 10/01/15 Active 04/15/16
Nerve Blocks for Peripheral Neuropathy
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35222 NEURO-014 10/01/15 Active 10/01/15
Nerve Conduction Studies and Electromyography
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34594 NEURO-005 10/01/15 Active 10/01/16
Non-Coronary Vascular Stents
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35998 CV-049 10/01/15 Active 10/01/16
Non-Invasive Abdominal / Visceral Vascular Studies
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35755 CV-048 10/01/15 Active 10/01/16
Non-Invasive Cerebrovascular Studies
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35753 CV-045 10/01/15 Active 10/01/16
Non-Invasive Peripheral Arterial Vascular Studies
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35761 CV-046 10/01/15 Active 10/01/16
Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35751 CV-047 10/01/15 Active 10/01/16
Pelvic Floor Dysfunction: Anorectal Manometry and EMG
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35486 GU-022 10/01/15 Active 10/01/16
Percutaneous Coronary Interventions (PCI)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34761 CV-044 10/01/15 Active 10/01/16
Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L36000 GSURG-055 12/17/15 Active 02/01/16
Polysomnography and Other Sleep Studies
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34535 NEURO-009 10/01/15 Active 10/01/16
Posterior Tibial Nerve Stimulation PTNS
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34436 GSURG-043 10/01/15 Active 10/01/16
Proton Beam Therapy
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34634 RAD-040 10/01/15 Active 11/01/15
Psychiatry and Psychology Services
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34616 PSYCH-014 10/01/15 Active 10/01/16
Psychological and Neuropsychological Testing
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34646 PSYCH-017 10/01/15 Active 02/01/16
Removal of Benign Skin Lesions
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L35498 DERM-011 10/01/15 Active 02/01/16
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34760 OPHTH-015 10/01/15 Active 10/01/16
Somatosensory Testing
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34624 NEURO-013 10/01/15 Active 10/01/16
Surgical Treatment of Obstructive Sleep Apnea (OSA)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34526 ENT-012 10/01/15 Active 02/01/16
Transcranial Magnetic Stimulation (TMS)
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34641 NEURO-010 10/01/15 Active 12/01/15
Treatment of Varicose Veins of the Lower Extremities
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34536 GSURG-041 10/01/15 Active 12/01/15
Trigger Points, Local Injections
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34588 MS-008 10/01/15 Active 03/01/16
Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34592 RAD-032 10/01/15 Active 02/01/16
Visual Fields
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34615 OPHTH-054 10/01/15 Active 10/01/16
Vitamin D Assay Testing
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34658 PATH-032 10/01/15 Active 10/01/16
Wound Care
Iowa ¦ Kansas ¦ Missouri ¦ Nebraska
L34587 GSURG-051 10/01/15 Active 03/01/16

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