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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.

February 2016

POLICIES WILL BE AVAILABLE ON THE CMS AND WPS GHA WEBSITES ON 01/28/2016.

Policy Title MCD Policy # WPS Policy # Effective Date
Allergy Testing and Allergy Immunotherapy L34597 ALRG-001 03/17/2016
This LCD is being retired and replaced by L36402 and L36408.

January 2016

POLICIES WILL BE AVAILABLE ON THE CMS AND WPS GHA WEBSITES ON 12/31/2015.

Policy Title MCD Policy # WPS Policy # Effective Date
Health and Behavior Assessment/Intervention L34603 PSYCH-015 01/01/2016
This Local Coverage Determination (LCD) is being retired.
Low Vision Services L34532 OPHTH-026 01/01/2016
This Local Coverage Determination (LCD) is being retired.
Routine Foot Care L34586 FT-001 02/15/2016
This Local Coverage Determination (LCD) is being retired and replaced by L36404 Foot Care.

December 2015

Policy Title MCD Policy # WPS Policy # Effective Date
Electroconvulsive Therapy (ECT) L34595 PSYCH-025 12/01/2015
See Medicare Claims Processing Manual, CMS Internet-Only Manual (IOM), Publication 100-04, Chapter 3, Section 19.7.3 for guidance.
Psychological Services under the "Incident to" Provision L34591 PSYCH-013 12/01/2015
See Medicare Benefit Policy Manual, CMS Internet-Only Manual (IOM), Publication 100-2, Chapter 15, Section 60-60.4 for guidance.
Stereotactic Computer Assisted Volumetric and/or Navigational Procedure L34599 GSURG-050 12/01/2015
Thrombopoietic Growth Factor - Oprelvekin L34602 INJ-034 12/01/2015