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Retired Policies

The following are retired policies. To access the policies listed on this page, make a note of the MCD Policy #, then enter that number in the Document ID field on the CMS Medicare Coverage Database (MCD). Be sure to note the retired effective date of the retired policy, as the policy will not appear as retired until the retired effective date. Prior to the retired effective date, the policy can be accessed by selecting the Local Coverage Determinations (LCD) link from the list of Policy links on the left side of this web page.

To access a previously retired policy (no longer included on this page), please visit the CMS MCD Archive Search web page.

April 2014

POLICIES WILL BE AVAILABLE ON THE CMS AND WPS MEDICARE WEBSITES ON 03/27/2014.

There are no retired policies for April 2014.


March 2014

POLICIES WILL BE AVAILABLE ON THE CMS AND WPS MEDICARE WEBSITES ON 02/27/2014.

Policy Title MCD Policy # WPS Policy # Effective Date
Outpatient Rehabilitation Therapy Services billed to Medicare Part B and the Billing and Coding Guidelines L28531 PHYSMED-009 03/01/2014
This LCD is being retired. The Medicare Internet Only Manual (IOM) instructions still apply to providers of these services. Information can be found in the following IOM manuals:
CMS Publication 100-02 Medicare Benefit Policy Manual, Chapter 15, sections 220 and 230, Chapter 16 section 18
0 CMS Publication 100-03 Medicare National Coverage Determinations Manual, section 160.27, 270.6
CMS Publication 100-04 Medicare Claims Processing Manual-Chapter 5, section 20.4 and Chapter 20 section 30.1.2.

Note: The following ICD-9 codes were inadvertently removed from the policy with the last update. They have been added back into the Group 3 diagnosis code list that is associated with CPT code 97026: 356.2, 674.12-674.14, 674.22-674.24, 870.1-870.2, 870.4, 871.2, 871.4, 871.6, 872.02, 872.11-872.12, 872.63-872.74, 872.9, 873.21-873.23, 873.31-873.39, 873.44-873.50, 873.54-873.59, 873.61-873.62, 873.64-873.69, 873.71-873.79, 878.6-878.7, 879.9, 880.01-880.02, 880.09, 880.11-880.12, 880.19, 882.2, 884.0-884.2, 885.1, 886.1, 887.1, 887.3, 887.5, 894.0-894.2, 895.1, 896.1, 897.1, 897.3, 897.5. The complete list of codes is listed in Publication 100-04, Medicare Claims Processing Manual, Chapter 5, section 20.4.


February 2014

POLICIES WILL BE AVAILABLE ON THE CMS AND WPS MEDICARE WEBSITES ON 01/30/2014.

There are no retired policies for February 2014


Page Last Updated: Thursday, 20-Mar-2014 13:24:04 CDT