Local Coverage Determinations (LCD)

General Information

CMS Internet-Only Manuals (IOMs)(external link)

LCD Reconsideration Process

The official Local Coverage Determination (LCD) is the version on the Medicare Coverage Database at http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx(external link)

The Local Coverage Determinations (LCDs) on this website were converted from PDF files to HTML to make it easier to find an LCD using the search function. PDF versions of these LCDs are still available on the CMS website(external link). We recommend you make a note of the document ID before selecting this link as it will enable you to access the policies more quickly.

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
3D Interpretation and Reporting of Imaging Studies L30729 RAD-037 07/16/10 Active 10/01/11
Ablative Therapy L30312 GSURG-033 09/15/09 Active 04/25/11
Acute Inpatient Services versus Observation (Outpatient) Services L32222 HOSP-001 03/17/12 Active NA
Allergy Testing and Allergy Immunotherapy L30471 ALRG-001 02/16/10 Active 10/01/11
Application of Bioengineered Skin Substitutes L30135 GSURG-052 08/16/09 Active 05/01/12
Bisphosphonate Drug Therapy L30139 INJ-025 10/16/09 Active 02/21/11
Blepharoplasty, Blepharoptosis and Brow Lift L29973 OPHTH-022 07/16/09 Active 04/01/11
Bone Mass Measurement L31620 MS-004 08/15/11 Active 04/01/12
Brachytherapy L30320 RAD-036 08/16/09 Active 10/01/11
Capsule Endoscopy L30141 GI-009 12/16/09 Active 03/01/12
Cardiac Catheterization and Coronary Angiography L30719 CV-006 07/16/10 Active 10/01/11
Cardiovascular Stress Testing L28563 CV-004 02/16/09 Active 10/01/11
Cataract Surgery and Complex Cataract Surgery L30159 OPHTH-020 12/16/09 Active 02/21/11
Circulating Tumor Cell Marker Assays L32218 PATH-033 02/15/12 Active 02/15/12
Colonoscopy and Sigmoidoscopy-Diagnostic L30304 GI-006 09/15/09 Active 03/01/12
Computed Coronary Tomography Angiography L30288 RAD-034 08/16/09 Active 04/01/12
Computerized Corneal Topography L31064 OPHTH-014 12/16/10 Active 07/01/11
Computerized Tomography (CAT Scans) L28544 RAD-033 03/25/09 Active 01/01/12
Corneal Pachymetry L30485 OPHTH-025 03/18/10 Active 10/01/11
Cosmetic and Reconstructive Surgery L30733 GSURG-032 11/15/10 Active 10/01/11
Cranial Stereotactic Radiosurgery (SRS) and Cranial Stereotactic Radiotherapy (SRT) L30318 RAD-018 08/16/09 Active 09/01/11
CT Colonography (Virtual Colonoscopy [VC]) L30300 RAD-035 11/15/09 Active 10/01/11
Cytogenetic Studies L30487 PATH-027 03/18/10 Active 10/01/11
Diagnostic Pap Tests L31080 GU-020 11/15/10 Active 02/21/11
Dialysis Shunt Maintenance L32009 CV-027 01/16/12 Active NA
Drugs and Biologics (Non-chemotherapy) L32013 INJ-041 11/15/11 Active 01/01/12
Dysphagia L2603 NA 12/12/00 Active 02/21/11
Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) L29584 CV-016 10/16/09 Active 05/01/12
Electroconvulsive Therapy (ECT) L30493 PSYCH-025 07/15/10 Active 02/21/11
Electromagnetic Navigation Bronchoscopy (ENB) L30510 PULM-007 02/15/10 Active 10/01/11
Endoscopic Treatment of GERD L30473 GI-010 04/15/10 Active 03/01/12
Epidural and Transforaminal Epidural Injections L30481 NEURO-007 04/15/10 Active 01/01/12
Erythropoiesis Stimulating Agents L31074 INJ-023 12/15/10 Active 02/21/11
Flow Cytometry L30161 PATH-016 11/16/09 Active 10/01/11
Fluorescein or Indocyanine Green Angiography L30727 OPHTH-016 10/16/10 Active 02/21/11
Health and Behavior Assessment/Intervention L30514 PSYCH-015 03/18/10 Active 02/21/11
Heavy Metal Testing L31067 PATH-028 12/16/10 Active 02/21/11
Helicobacter Pylori Testing L30163 PATH-026 10/16/09 Active 04/01/12
Hemophilia Clotting Factors L31078 INJ-003 11/15/10 Active 01/01/12
Home and Domiciliary Services L31613 PHYS-081 06/15/11 Active NA
Human Granulocyte/Macrophage Colony Stimulating Factors L30306 INJ-019 09/15/09 Active 11/01/11
Immune Globulins L30147 INJ-012 11/15/09 Active 01/01/12
Immunizations L31084 ALRG-003 11/15/10 Active 02/21/11
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L30153 MS-007 10/16/09 Active 01/01/12
Intra-articular Injections of Hyaluronan L30149 INJ-033 10/16/09 Active 03/01/12
Intra-operative Neurophysiological Testing L30721 GSURG-034 02/15/11 Active 03/01/12
Low Vision Services L32007 OPHTH-026 02/15/12 Active 04/01/12
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs L30479 INJ-039 03/18/10 Active 07/01/11
Magnetic Resonance Angiography L31355 RAD-023 04/15/11 Active 12/01/11
Magnetic Resonance Imaging L28723 RAD-024 03/25/09 Active 02/01/12
Moderate (Conscious) Sedation L29582 AN-030 07/16/09 Active 04/01/11
Mohs Micrographic Surgery L30713 DERM-004 07/16/10 Active 03/01/12
Myocardial Perfusion Imaging and Cardiac Blood Pool Studies L31072 CV-017 11/15/10 Active 10/01/11
Nerve Conduction Studies and Electromyography L31346 NEURO-005 04/15/11 Active 01/01/12
Non-coronary Vascular Stents L30798 CV-028 07/16/10 Active 02/21/11
Noninvasive Vascular Testing (N.I.V.T.) L28586 CV-033 05/18/09 Active 10/01/11
Ophthalmic Biometry L31624 OPHTH-006 07/16/11 Active NA
Optical Coherence Tomography (OCT) L29971 OPHTH-015 10/16/09 Active 10/01/11
Paravertebral Facet Joint Block and Facet Joint Denervation L30483 NEURO-008 03/18/10 Active 01/01/12
Percutaneous Coronary Interventions (PCI) L28478 NA 02/16/09 Active 02/21/11
Polysomnography and Other Sleep Studies L31082 NEURO-009 12/16/10 Active 07/01/11
Proton Beam Therapy L31617 RAD-040 03/17/12 Active 05/01/12
Psychiatric Inpatient Hospitalization L30441 PSYCH-020 03/18/10 Active 02/21/11
Psychiatric Partial Hospitalization Program (PHP) L30491 PSYCH-016 10/16/10 Active 02/21/11
Psychiatry and Psychology Services L30489 PSYCH-014 03/18/10 Active 05/15/12
Psychological and Neuropsychological Testing L31990 PSYCH-017 05/15/2012 Active NA
Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) L30316 RAD-014 08/16/09 Active 12/01/11
Radiofrequency Treatment for Urinary Incontinence L31615 GU-021 06/15/11 Active 04/01/12
Radiopharmaceutical Agents L31361 RAD-026 07/16/11 Active 05/01/12
Removal of Benign Skin Lesions L30330 DERM-008 08/16/09 Active 05/01/12
Routine Foot Care L30322 FT-001 08/16/09 Active 05/01/12
Sacroiliac Joint Injections L31359 MS-009 02/15/11 Active 01/01/12
Selective Internal Radiation Therapy (SIRT) for Primary and Secondary Hepatic Malignancy (90YMicrosphere Hepatic Brachytherapy) L30137 RAD-038 10/16/09 Active 02/21/11
Sentinel Lymph Node Biopsy L30475 GSURG-036 07/16/10 Active 05/01/12
Stereotactic Body Radiation Therapy L28366 RAD-039 07/16/08 Active 07/01/11
Stereotactic Computer Assisted Volumetric and/or Navigational Procedure L29586 GSURG-050 08/16/09 Active 09/01/11
Surgical Treatment of Obstructive Sleep Apnea (OSA) L30731 ENT-012 07/16/10 Active 11/01/11
Thrombopoietic Growth factor - Oprelvekin L30151 INJ-034 11/15/09 Active 10/01/11
Transcranial Magnetic Stimulation (TMS) L32220 NEURO-010 04/16/12 Active NA
Transesophageal Echocardiography (Including Intraoperative TEE) L28574 CV-007 03/18/09 Active 10/01/11
Transthoracic Echocardiography (TTE) L28565 CV-026 03/25/09 Active 10/01/11
Treatment of Varicose Veins of the Lower Extremities L30143 GSURG-041 11/15/09 Active 03/01/12
Trigger Points, Local Injections L30155 MS-008 10/16/09 Active 03/01/12
Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency L32452 CV-042 06/15/12 Final NA
Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation L30516 RAD-032 07/16/10 Active 06/01/11
Visual Fields L31348 OPHTH-054 04/15/11 Active 10/01/11
Vitamin B 12 Injections L30145 INJ-004 09/15/09 Active 02/21/11
Vitamin D Assay Testing L31076 PATH-032 12/15/10 Active 04/01/12
Wound Care L28572 GSURG-051 09/15/09 Active 05/01/12

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Page Last Updated: Tuesday, 22-May-2012 09:01:23 CDT