Local Policies (LCD)

Home Provider Part B Policy/Coverage Active Policies Local

CMS Medicare Coverage Database external link

The official Local Coverage Determination (LCD) is the version on the Medicare Coverage Database at www.cms.gov/MCD external link

Title CMS ID# Original Effective Date Status Last Revision Date
3D Interpretation and Reporting of Imaging Studies L30729 07/16/10 Active N/A
Ablative Therapy L30312 09/15/09 Active 04/19/10
Alfacept Therapy L16607
L16611
L16613
L16615		 09/16/04 Active 09/15/06
Allergy Testing and Allergy Immunotherapy L30471 02/16/10 Active 04/19/10
Angiography - Retinal/Choroidal with Fluorescein or Indocyanine Green L17997
L17998
L17999
L18000		 11/01/95 Retire 10/15/10
Replaced by
L30727		 10/01/06
Application of Bioengineered Skin Substitutes L30135 08/16/09 Active 04/19/10
Biofeedback L20055
L20056
L20057
L20058		 12/15/2001 Active 06/01/09
Bisphosphonate Drug Therapy L30139 10/16/09 Active 04/19/10
Blepharoplasty, Blepharoptosis and Brow Lift L29973 07/16/09 Active 04/19/10
Bone Mass Measurement L28527 03/18/09 Active 08/01/10
Botulinum Toxin Type A & Type B L28555 05/16/09 Active 09/01/10
Brachytherapy L30320 08/16/09 Active 04/19/10
Capsule Endoscopy L30141 12/16/09 Active 04/19/10
Cardiac Catheterization and Coronary Angiography L30719 07/16/10 Active N/A
Cardiovascular Stress Testing L28563 02/16/09 Active 05/06/10
Cataract Surgery and Complex Cataract Surgery L30159 12/16/09 Active 04/19/10
Chemotherapy Drugs and their Adjuncts L28576 05/16/09 Active 09/01/10
Chiropractic Services L30328 09/15/09 Active 09/15/09
Colonoscopy and Sigmoidoscopy-Diagnostic L30304 09/15/09 Active 04/19/10
Computed Coronary Tomography Angiography L30288 08/16/09 Active 04/19/10
Computerized Corneal Topography L17468
L17469
L17470
L17471		 01/01/94 Active 01/01/07
Computerized Tomography (CAT Scans) L28544 03/25/09 Active 04/19/10
Corneal Pachymetry L30485 03/18/10 Active 04/19/10
Cosmetic and Reconstructive Surgery L17993
L17994
L17995
L17996		 09/16/04 Active 12/01/09
Cranial Stereotactic Radiosurgery (SRS) and Cranial Stereotactic Radiotherapy (SRT) L30318 08/16/09 Active 04/19/10
CT Colonography (Virtual Colonoscopy [VC]) L30300 11/15/09 Active 04/19/10
Cytogenetic Studies L30487 03/18/10 Active 04/19/10
Diagnostic Mammogram L20059
L20060
L20061
L20062		 05/25/94 Active 10/01/08
Diagnostic PAP Tests L18026
L18028
L18030
L18032		 07/01/94 Active 10/01/07
Dialysis Shunt Maintenance L20049
L20050
L20051
L20052		 12/01/99 Active 01/01/10
Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) L29584 10/16/09 Active 04/19/10
Electroconvulsive Therapy (ECT) L30493 07/15/10 Active N/A
Electromagnetic Navigation Bronchoscopy (ENB) L30510 02/15/10 Active 04/19/10
Endoscopic Treatment of GERD L30473 04/15/10 Active 04/19/10
Epidural and Transforaminal Epidural Injections L30481 04/15/10 Active 07/30/10
Erythropoiesis Stimulating Proteins Epoetin alfa (EPO), Darbepoetin alfa (DPA) L17842
L17843
L17844
L17845		 01/01/90 Active 11/16/09
Flow Cytometry L30161 11/16/09 Active 08/01/10
Fluorescein or Indocyanine Green Angiography L30727 10/16/10 Final 09/01/10
Health and Behavior Assessment/Intervention L30514 03/18/10 Active 04/19/10
Heavy Metal Testing L17611
L20492
L20493
L20494		 12/01/00 Active 10/01/05
Helicobacter Pylori Testing L30163 10/16/09 Active 04/19/10
Home and Domiciliary Services L26230 04/16/08 Active NA
Human Granulocyte/Macrophage Colony Stimulating Factors L30306 09/15/09 Active 09/01/10
Immune Globulins L30147 11/15/09 Active 07/01/10
Immunizations L16791
L16792
L16793
L16794		 06/15/04 Active 01/01/10
Independent Diagnostic Testing Facilities (IDTFs) L23448 06/16/07 Active 01/01/10
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L30153 10/16/09 Active 04/19/10
Intra-articular Injections of Hyaluronan L30149 10/16/09 Active 04/19/10
Intra-operative Neurophysiological Testing L10944
L20845
L20846
L20847		 04/01/99 Active 08/01/05
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs L30479 03/18/10 Active 04/19/10
Magnetic Resonance Imaging L28723 03/25/09 Active 04/19/10
Moderate (Conscious) Sedation L29582 07/16/09 Active 04/19/10
Mohs Micrographic Surgery L30713 07/16/10 Active N/A
Myocardial Perfusion Imaging L17678
L17684
L17685
L17686		 10/01/93 Active 01/01/10
Nerve Conduction Studies and Electromygraphy L26233 09/01/03 Active 01/01/10
Non-coronary Vascular Stents L30798 07/16/10 Active 07/16/2010
Noninvasive Vascular Testing (N.I.V.T.) L28586 05/18/09 Active 05/01/10
Ophthalmic Biometry L16826
L16827
L16828
L16829		 01/01/93 Active 07/01/06
Optical Coherence Tomography (OCT) L29971 10/16/09 Active 04/19/10
Optometrist Services L30157 01/16/10 Active 04/19/10
Outpatient Rehabilitation Therapy Services billed to Medicare Part B L28531 01/15/10 Active 01/15/10
Paravertebral Facet Joint Block and Facet Joint Denervation L30483 03/18/10 Active 04/19/10
Percutaneous Coronary Interventions (PCI) L28478 02/16/09 Active 04/19/10
Posterior Tibial Nerve Stimulation PTNS L28457 02/16/09 Active 08/01/09
Psychiatric Partial Hospitalization Program (PHP) L30491 10/16/10 Final NA
Psychiatry and Psychological Services L30489 03/18/10 Active 09/01/10
Psychological Services under the Incident to provision L18009
L18010
L18011
L18012		 05/01/01 Retire
09/15/10
Replaced by L30715		 08/01/04
Psychological Services under the "Incident to" Provision L30715 09/16/10 Final NA
Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) L30316 08/16/09 Active 04/19/10
Radiopharmaceutical Agents L7388
L20787
L20788
L20789		 10/01/95 Active 03/01/09
Removal of Benign Skin Lesions L30330 08/16/09 Active 06/01/10
RHo (D) Immune Globulin L15285
L15371
L15372
L15373		 01/01/96 Retire
09/30/10		 01/01/09
Routine Foot Care And Debridement Of Nails L30322 08/16/09 Active 04/19/10
Selective Internal Radiation Therapy (SIRT) for Primary and Secondary Hepatic Malignancy (90YMicrosphere Hepatic Brachytherapy) L30137 10/16/09 Active 04/19/10
Sentinel Lymph Node Biopsy L30475 07/16/10 Active N/A
Stereotactic Body Radiation Therapy L28366 07/16/08 Active 01/01/10
Stereotactic Computer Assisted Volumetric and/or Navigational Procedure L29586 08/16/09 Active 04/19/10
Surgical Treatment of Obstructive Sleep Apnea (OSA) L30731 07/16/10 Active N/A
Syphilis Testing L16838
L16840
L16841
L16842		 01/15/04 Active 01/01/10
Thrombopoietic Growth factor - Oprelvekin L30151 11/15/09 Active 04/19/10
Transesophageal Echocardiography (Including Intraoperative TEE) L28574 03/18/09 Active 04/19/10
Transthoracic Echocardiography (TTE) L28565 03/25/09 Active 04/19/10
Treatment of Varicose Veins of the Lower Extremities L30143 11/15/09 Active 04/19/10
Trigger Points, Local Injections L30155 10/16/09 Active 04/19/10
Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation L30516 07/16/10 Active N/A
Vitamin B 12 Injections L30145 09/15/09 Active 08/13/10
Wound Care L28572 09/15/09 Active 05/01/10

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Page Last Updated: Wednesday, 01-Sep-2010 11:32:17 CDT