Local Coverage Determinations (LCD)
CMS Internet-Only Manuals (IOMs)(external link)
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)
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 |
|---|---|---|---|---|---|
| Ablative Therapy Illinois ¦ Minnesota ¦ Wisconsin |
L30312 | GSURG-033 | 09/15/09 | Active | 04/01/13 |
| Allergy Testing and Allergy Immunotherapy Illinois ¦ Minnesota ¦ Wisconsin |
L30471 | ALRG-001 | 02/16/10 | Active | 05/01/13 |
| Application of Bioengineered Skin Substitutes Illinois ¦ Minnesota ¦ Wisconsin |
L30135 | GSURG-052 | 08/16/09 | Active | 01/01/13 |
| Bariatric Surgery for Morbid Obesity Illinois ¦ Minnesota ¦ Wisconsin |
L32904 | GSURG-042 | 02/15/13 | Active | 03/01/13 |
| Bisphosphonate Drug Therapy Illinois ¦ Minnesota ¦ Wisconsin |
L30139 | INJ-025 | 10/16/09 | Active | 10/22/12 |
| Blepharoplasty, Blepharoptosis and Brow Lift Illinois ¦ Minnesota ¦ Wisconsin |
L29973 | OPHTH-022 | 07/16/09 | Active | 10/22/12 |
| Bone Mass Measurement Illinois ¦ Minnesota ¦ Wisconsin |
L31620 | MS-004 | 08/15/11 | Active | 10/22/12 |
| Botulinum Toxin Type A & Type B Illinois ¦ Minnesota ¦ Wisconsin |
L28555 | INJ-018 | 05/16/09 | Active | 01/01/13 |
| Brachytherapy Illinois ¦ Minnesota ¦ Wisconsin |
L30320 | RAD-036 | 08/16/09 | Active | 05/01/13 |
| Capsule Endoscopy Illinois ¦ Minnesota ¦ Wisconsin |
L30141 | GI-009 | 12/16/09 | Active | 01/01/13 |
| Cardiac Catheterization and Coronary Angiography Illinois ¦ Minnesota ¦ Wisconsin |
L30719 | CV-006 | 07/16/10 | Active | 10/22/12 |
| Cardiovascular Stress Testing Illinois ¦ Minnesota ¦ Wisconsin |
L28563 | CV-004 | 02/16/09 | Active | 10/22/12 |
| Cataract Surgery and Complex Cataract Surgery Illinois ¦ Minnesota ¦ Wisconsin |
L30159 | OPHTH-020 | 12/16/09 | Active | 10/22/12 |
| Category III Codes Illinois ¦ Minnesota ¦ Wisconsin |
L32569 | PHYS-082 | 11/16/12 | Active | 02/01/13 |
| Chemotherapy Drugs and their Adjuncts Illinois ¦ Minnesota ¦ Wisconsin |
L28576 | HONC-010 | 05/16/09 | Active | 04/01/13 |
| Chiropractic Services Illinois ¦ Minnesota ¦ Wisconsin |
L30328 | CHIRO-001 | 09/15/09 | Active | 03/01/13 |
| Circulating Tumor Cell Marker Assays Illinois ¦ Minnesota ¦ Wisconsin |
L32218 | PATH-033 | 02/15/12 | Active | 01/01/13 |
| Colonoscopy and Sigmoidoscopy-Diagnostic Illinois ¦ Minnesota ¦ Wisconsin |
L30304 | GI-006 | 09/15/09 | Active | 10/22/12 |
| Computed Coronary Tomography Angiography Illinois ¦ Minnesota ¦ Wisconsin |
L30288 | RAD-034 | 08/16/09 | Active | 10/22/12 |
| Computerized Corneal Topography Illinois ¦ Minnesota ¦ Wisconsin |
L31064 | OPHTH-014 | 12/16/10 | Active | 10/22/12 |
| Corneal Pachymetry Illinois ¦ Minnesota ¦ Wisconsin |
L30485 | OPHTH-025 | 03/18/10 | Active | 10/22/12 |
| Cosmetic and Reconstructive Surgery Illinois ¦ Minnesota ¦ Wisconsin |
L30733 | GSURG-032 | 11/15/10 | Active | 01/01/13 |
| Cranial Stereotactic Radiosurgery (SRS) and Cranial Stereotactic Radiotherapy (SRT) Illinois ¦ Minnesota ¦ Wisconsin |
L30318 | RAD-018 | 08/16/09 | Active | 10/22/12 |
| CT Colonography (Virtual Colonoscopy [VC]) Illinois ¦ Minnesota ¦ Wisconsin |
L30300 | RAD-035 | 11/15/09 | Active | 10/22/12 |
| Cytogenetic Studies Illinois ¦ Minnesota ¦ Wisconsin |
L30487 | PATH-027 | 03/18/10 | Active | 10/22/12 |
| Diagnostic Pap Tests Illinois ¦ Minnesota ¦ Wisconsin |
L31080 | GU-020 | 11/15/10 | Active | 05/01/13 |
| Drugs and Biologics (Non-chemotherapy) Illinois ¦ Minnesota ¦ Wisconsin |
L32013 | INJ-041 | 11/15/11 | Active | 01/01/13 |
| Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) Illinois ¦ Minnesota ¦ Wisconsin |
L29584 | CV-016 | 10/16/09 | Active | 01/01/13 |
| Electroconvulsive Therapy (ECT) Illinois ¦ Minnesota ¦ Wisconsin |
L30493 | PSYCH-025 | 07/15/10 | Active | 10/22/12 |
| Electromagnetic Navigation Bronchoscopy (ENB) Illinois ¦ Minnesota ¦ Wisconsin |
L30510 | PULM-007 | 02/15/10 | Active | 10/22/12 |
| Endoscopic Treatment of GERD Illinois ¦ Minnesota ¦ Wisconsin |
L30473 | GI-010 | 04/15/10 | Active | 01/01/13 |
| Epidural and Transforaminal Epidural Injections Illinois ¦ Minnesota ¦ Wisconsin |
L30481 | NEURO-007 | 04/15/10 | Active | 10/22/12 |
| Erythropoiesis Stimulating Agents - Epoetin alfa, Darbepoetin alfa, Peginesatide Illinois ¦ Minnesota ¦ Wisconsin |
L31074 | INJ-023 | 12/15/10 | Active | 04/01/13 |
| Flow Cytometry Illinois ¦ Minnesota ¦ Wisconsin |
L30161 | PATH-016 | 11/16/09 | Active | 04/01/13 |
| Health and Behavior Assessment/Intervention Illinois ¦ Minnesota ¦ Wisconsin |
L30514 | PSYCH-015 | 03/18/10 | Active | 04/01/13 |
| Heavy Metal Testing Illinois ¦ Minnesota ¦ Wisconsin |
L31067 | PATH-028 | 12/16/10 | Active | 10/22/12 |
| Hemophilia Clotting Factors Illinois ¦ Minnesota ¦ Wisconsin |
L31078 | INJ-003 | 11/15/10 | Active | 10/22/12 |
| Home and Domiciliary Services Illinois ¦ Minnesota ¦ Wisconsin |
L31613 | PHYS-081 | 06/15/11 | Active | 01/01/13 |
| Human Granulocyte/Macrophage Colony Stimulating Factors Illinois ¦ Minnesota ¦ Wisconsin |
L30306 | INJ-019 | 09/15/09 | Active | 10/22/12 |
| Immune Globulins Illinois ¦ Minnesota ¦ Wisconsin |
L30147 | INJ-012 | 11/15/09 | Active | 04/01/13 |
| Immunizations Illinois ¦ Minnesota ¦ Wisconsin |
L31084 | ALRG-003 | 11/15/10 | Active | 05/01/13 |
| Independent Diagnostic Testing Facilities (IDTFs) Illinois ¦ Minnesota ¦ Wisconsin |
L31626 | PHYS-078 | 09/15/11 | Active | 08/20/12 |
| Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma Illinois ¦ Minnesota ¦ Wisconsin |
L30153 | MS-007 | 10/16/09 | Active | 10/22/12 |
| Intra-articular Injections of Hyaluronan Illinois ¦ Minnesota ¦ Wisconsin |
L30149 | INJ-033 | 10/16/09 | Active | 10/22/12 |
| Intra-operative Neurophysiological Testing Illinois ¦ Minnesota ¦ Wisconsin |
L30721 | GSURG-034 | 02/15/11 | Active | 01/01/13 |
| Low Vision Services Illinois ¦ Minnesota ¦ Wisconsin |
L32007 | OPHTH-026 | 02/15/12 | Active | 10/22/12 |
| Luteinizing Hormone-Releasing Hormone (LHRH) Analogs Illinois ¦ Minnesota ¦ Wisconsin |
L30479 | INJ-039 | 03/18/10 | Active | 10/22/12 |
| Moderate (Conscious) Sedation Illinois ¦ Minnesota ¦ Wisconsin |
L29582 | AN-030 | 07/16/09 | Active | 01/01/13 |
| Mohs Micrographic Surgery Illinois ¦ Minnesota ¦ Wisconsin |
L30713 | DERM-004 | 07/16/10 | Active | 10/22/12 |
| Myocardial Perfusion Imaging and Cardiac Blood Pool Studies Illinois ¦ Minnesota ¦ Wisconsin |
L31072 | CV-017 | 11/15/10 | Active | 10/22/12 | Nerve Blocks for Peripheral Neuropathy Illinois ¦ Minnesota ¦ Wisconsin |
L32565 | NEURO-011 | 10/16/12 | Active | 10/22/12 |
| Nerve Conduction Studies and Electromyography Illinois ¦ Minnesota ¦ Wisconsin |
L31346 | NEURO-005 | 04/15/11 | Active | 05/01/13 |
| Non-coronary Vascular Stents Illinois ¦ Minnesota ¦ Wisconsin |
L30798 | CV-028 | 07/16/10 | Active | 10/22/12 |
| Noninvasive Vascular Testing (N.I.V.T.) Illinois ¦ Minnesota ¦ Wisconsin |
L28586 | CV-033 | 05/18/09 | Active | 11/01/12 |
| Ophthalmic Biometry Illinois ¦ Minnesota ¦ Wisconsin |
L31624 | OPHTH-006 | 07/16/11 | Active | 10/22/12 |
| Optical Coherence Tomography (OCT) Illinois ¦ Minnesota ¦ Wisconsin |
L29971 | OPHTH-015 | 10/16/09 | Active | 10/22/12 |
| Outpatient Rehabilitation Therapy Services billed to Medicare Part B Illinois ¦ Minnesota ¦ Wisconsin |
L28531 | PHYSMED-009 | 01/15/10 | Active | 03/01/13 |
| Paravertebral Facet Joint Block and Facet Joint Denervation Illinois ¦ Minnesota ¦ Wisconsin |
L30483 | NEURO-008 | 03/18/10 | Active | 10/22/12 |
| Percutaneous Coronary Interventions (PCI) Illinois ¦ Minnesota ¦ Wisconsin |
L28478 | CV-037 | 02/16/09 | Active | 03/01/13 |
| Polysomnography and Other Sleep Studies Illinois ¦ Minnesota ¦ Wisconsin |
L31082 | NEURO-009 | 12/16/10 | Active | 03/01/13 |
| Posterior Tibial Nerve Stimulation PTNS Illinois ¦ Minnesota ¦ Wisconsin |
L28457 | GSURG-043 | 02/16/09 | Active | 10/22/12 |
| Proton Beam Therapy Illinois ¦ Minnesota ¦ Wisconsin |
L31617 | RAD-040 | 03/17/12 | Active | 12/01/12 |
| Psychiatric Partial Hospitalization Program (PHP) Illinois ¦ Minnesota ¦ Wisconsin |
L30491 | PSYCH-016 | 10/16/10 | Active | 01/01/13 |
| Psychiatry and Psychology Services Illinois ¦ Minnesota ¦ Wisconsin |
L30489 | PSYCH-014 | 03/18/10 | Active | 05/01/13 |
| Psychological and Neuropsychological Testing Illinois ¦ Minnesota ¦ Wisconsin |
L31990 | PSYCH-017 | 05/15/2012 | Active | 10/22/12 |
| Psychological Services under the "Incident to" Provision Illinois ¦ Minnesota ¦ Wisconsin |
L30715 | PSYCH-013 | 09/16/10 | Active | 05/01/13 |
| Qualitative Drug Testing Illinois ¦ Minnesota ¦ Wisconsin |
L32450 | PATH-035 | 07/16/12 | Active | 10/22/12 |
| Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) Illinois ¦ Minnesota ¦ Wisconsin |
L30316 | RAD-014 | 08/16/09 | Active | 10/22/12 |
| Radiofrequency Treatment for Urinary Incontinence Illinois ¦ Minnesota ¦ Wisconsin |
L31615 | GU-021 | 06/15/11 | Active | 03/01/13 |
| Radiopharmaceutical Agents Illinois ¦ Minnesota ¦ Wisconsin |
L31361 | RAD-026 | 07/16/11 | Active | 05/01/13 |
| Removal of Benign Skin Lesions Illinois ¦ Minnesota ¦ Wisconsin |
L30330 | DERM-008 | 08/16/09 | Active | 10/22/12 |
| Routine Foot Care Illinois ¦ Minnesota ¦ Wisconsin |
L30322 | FT-001 | 08/16/09 | Active | 10/22/12 |
| Sacroiliac Joint Injections Illinois ¦ Minnesota ¦ Wisconsin |
L31359 | MS-009 | 02/15/11 | Active | 10/22/12 |
| Selective Internal Radiation Therapy (SIRT) for Primary and Secondary Hepatic Malignancy (90YMicrosphere Hepatic Brachytherapy) Illinois ¦ Minnesota ¦ Wisconsin |
L30137 | RAD-038 | 10/16/09 | Active | 10/22/12 |
| Sentinel Lymph Node Biopsy Illinois ¦ Minnesota ¦ Wisconsin |
L30475 | GSURG-036 | 07/16/10 | Active | 10/22/12 |
| Somatosensory Testing Illinois ¦ Minnesota ¦ Wisconsin |
L32902 | NEURO-013 | 02/15/13 | Active | NA |
| Stereotactic Body Radiation Therapy Illinois ¦ Minnesota ¦ Wisconsin |
L28366 | RAD-039 | 07/16/08 | Active | 10/22/12 |
| Stereotactic Computer Assisted Volumetric and/or Navigational Procedure Illinois ¦ Minnesota ¦ Wisconsin |
L29586 | GSURG-050 | 08/16/09 | Active | 04/01/13 |
| Surgical Treatment of Obstructive Sleep Apnea (OSA) Illinois ¦ Minnesota ¦ Wisconsin |
L30731 | ENT-012 | 07/16/10 | Active | 10/22/12 |
| Thrombopoietic Growth factor - Oprelvekin Illinois ¦ Minnesota ¦ Wisconsin |
L30151 | INJ-034 | 11/15/09 | Active | 10/22/12 |
| Transcranial Magnetic Stimulation (TMS) Illinois ¦ Minnesota ¦ Wisconsin |
L32220 | NEURO-010 | 04/16/12 | Active | 04/01/13 |
| Transesophageal Echocardiography (Including Intraoperative TEE) Illinois ¦ Minnesota ¦ Wisconsin |
L28574 | CV-007 | 03/18/09 | Active | 05/01/13 |
| Transthoracic Echocardiography (TTE) Illinois ¦ Minnesota ¦ Wisconsin |
L28565 | CV-026 | 03/25/09 | Active | 10/22/12 |
| Treatment of Varicose Veins of the Lower Extremities Illinois ¦ Minnesota ¦ Wisconsin |
L30143 | GSURG-041 | 11/15/09 | Active | 10/22/12 |
| Trigger Points, Local Injections Illinois ¦ Minnesota ¦ Wisconsin |
L30155 | MS-008 | 10/16/09 | Active | 03/01/13 |
| Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency Illinois ¦ Minnesota ¦ Wisconsin |
L32452 | CV-042 | 06/15/12 | Active | 10/22/12 |
| Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation Illinois ¦ Minnesota ¦ Wisconsin |
L30516 | RAD-032 | 07/16/10 | Active | 10/22/12 |
| Visual Fields Illinois ¦ Minnesota ¦ Wisconsin |
L31348 | OPHTH-054 | 04/15/11 | Active | 10/22/12 |
| Vitamin B 12 Injections Illinois ¦ Minnesota ¦ Wisconsin |
L30145 | INJ-004 | 09/15/09 | Active | 10/22/12 |
| Vitamin D Assay Testing Illinois ¦ Minnesota ¦ Wisconsin |
L31076 | PATH-032 | 12/15/10 | Active | 10/22/12 |
| Wound Care Illinois ¦ Minnesota ¦ Wisconsin |
L28572 | GSURG-051 | 09/15/09 | Active | 02/01/13 |
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Page Last Updated: Tuesday, 23-Apr-2013 08:44:28 CDT
