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

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LCD Reconsideration Process
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J5 MAC B Local Coverage Determinations (LCDs)

Title CMS ID# Original Effective Date Status Last Revision Date
Ablative Therapy L30312 09/15/09 Active NA
Allergy Immunotherapy L26618 02/01/08 Active 08/01/09
Allergy Testing and Allergy Immunotherapy L30471 02/16/10 Final NA
Allergy Testing L26620 02/01/08 Active 08/01/09
Analysis of Implantable Cardiac Devices L26639 02/01/08 Active 08/01/09
Application of Bioengineered Skin Substitutes L30135 08/16/09 Active 11/01/09
Biofeedback Therapy L26686 02/01/08 Active 08/01/09
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
Capsule Endoscopy L30141 12/16/09 Active NA
Cardiac Catheterization L26623 02/01/08 Active 10/01/09
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
Chiropractic Services L30328 09/15/09 Active 08/01/09
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
Corneal Topography L26671 02/01/08 Active 08/01/09
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
Cytogenetic Studies L26684 02/01/08 Retire
03/18/10		 08/01/09
Dysphagia, Diagnostic Evaluation L26689 02/01/08 Active 10/01/09
EEG – 24 Hour Monitoring L26664 02/01/08 Active 08/01/09
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
Endoscopic Treatment of GERD L26646 02/01/08 Active 08/01/09
Erythropoiesis Stimulating Agents L26655 02/01/08 Active 10/01/09
Flow Cytometry L30161 11/16/09 Active 12/01/09
Fluorescein Angiography L26672 02/01/08 Active 08/01/09
Gonadotropin Releasing Hormone Analogs L26657 02/01/08 Retire
03/17/10		 08/01/09
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
Immune Globulins L30147 11/15/09 Active NA
Implantable Infusion Pump L26659 02/01/08 Active 08/01/09
Independent Diagnostic Testing Facilities (IDTF) L26687 02/01/08 Active 01/01/10
Indocyanine Green Angiography and Angioscopy L26680 02/01/08 Active 08/01/09
Infliximab (Remicade) L26658 02/01/08 Active 08/01/09
Injection of Spinal Canal L26711 02/01/08 Active 01/01/10
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L30153 10/16/09 Active NA
Intra-articular Injections of Hyaluronan L30149 10/16/09 Active 01/01/10
LASIK Procedure for Postoperative Correction of Surgically Induced Astigmatism and/or Anisometropia L26681 02/01/08 Active 08/01/09
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs L30479 03/18/10 Final NA
Magnetic Resonance Angiography (MRA) of the Head and Neck, Chest, Abdomen & Pelvis, Lower Extremities L26696 02/01/08 Active 08/01/09
Magnetic Resonance Imaging L28723 03/25/09 Active 10/01/09
Moderate (Conscious) Sedation L29582 07/16/09 Active 08/01/09
Mohs' Micrographic Surgery L26640 02/01/08 Active 08/01/09
Myocardial Perfusion Imaging L26626 02/01/08 Active 08/01/09
Nerve Conduction Studies and Electromygraphy L26663 02/01/08 Active 08/01/09
Non-coronary Vascular Stents L26634 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 Rehabilitation Therapy Services billed to Medicare Part B L28531 01/15/10 Active 01/15/10
Pachymetry L26677 02/01/08 Retire
03/17/10		 08/01/09
Paravertebral Facet Joint Block and Facet Joint Denervation L30483 03/18/10 Final NA
Paravertebral Facet Joint Block and Facet Joint Denervation L26665 02/01/08 Retire
03/17/10		 01/01/10
Percutaneous Coronary Interventions (PCI) L28478 02/16/09 Active 08/01/09
Percutaneous Vertebroplasty, Kyphoplasty L26699 02/01/08 Active 08/01/09
Posterior Tibial Nerve Stimulation PTNS L28457 02/16/09 Active 08/01/09
Prostate Specific Antigen Testing L26685 02/01/08 Active 08/01/09
Psychiatry and Psychological Services L30489 03/18/10 Final NA
Psychiatric Pharmacotherapy L26691 02/01/08 Active 08/01/09
Psychiatry and Psychological Services, Incident To L26690 02/01/08 Active 08/01/09
Pulmonary Function Testing L26693 02/01/08 Active 08/01/09
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 Body Radiation Therapy L28366 07/16/08 Active 08/01/09
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
Visual Fields L26682 02/01/08 Active 10/01/09
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 14:29:03 CST