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Local Coverage Determinations (LCDs)

ICD-10 Information:

  • A list of Local Coverage Determinations (LCDs) converted to ICD-10 is available on the LCDs by Contractor Index.
  • The Special Edition article SE1421, "How to Access Updates to ICD-10 Local Coverage Determinations in the CMS Medicare Coverage Database," is available at http://go.cms.gov/1pcSQW0

CMS has contracted with CGS to process Durable Medical Equipment, Prosthetic, Orthotic and Supply (DMEPOS) claims for Jurisdiction C. This responsibility includes the development of Local Coverage Determinations (coverage policies).

Jurisdiction C is comprised of Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia and West Virginia.

Important Note: CGS does not house LCDs on our website. By clicking some of the links below, you will be sent directly to the CMS LCD database.


Local Coverage Determination HCPCS Codes

NOTE: The appearance of a code in this section does not necessarily indicate coverage

HCPCS Modifiers
Ankle-Foot/Knee-Ankle-Foot OrthosisExternal Website A4466, A9283, L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2106, L2108, L2112, L2114, L2116, L2126, L2128, L2132, L2134, L2136, L2180, L2182, L2184, L2186, L2188, L2190, L2192, L2200, L2210, L2220, L2230, L2310, L2330, L2232, L2240, L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2335, L2340, L2340, L2350, L2360, L2370, L2375, L2380, L2385, L2387, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2500, L2510, L2520, L2525, L2526, L2530, L2540, L2550, L2750, L2755, L2760, L2768, L2780, L2785, L2795, L2800, L2810, L2820, L2830, L2840, L2850, L2999, L4002, L4010, L4020, L4030, L4040, L4045, L4050, L4055, L4060, L4070, L4080, L4090, L4100, L4110, L4130, L4205, L4210, L4350, L4360, L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 EY, GA, GZ, KX, LT, RT
Automatic External DefibrillatorsExternal Website A9999, E0617, K0606, K0607, K0608, K0609 EY, GA, GZ, KF, KX
Canes and CrutchesExternal Website A4635, A4636, A4637, A9270, E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116, E0117, E0118, E0153 EY
Cervical Traction DevicesExternal Website E0840, E0849, E0850, E0855, E0856, E0860 EY, GA, GZ, KX
Cold TherapyExternal Website A9270, A9273, E0218 EY
CommodesExternal Website E0163, E0165, E0167, E0168, E0170, E0171, E0172, E0175, E0244 EY, GA, GY, GZ, KX
Enteral NutritionExternal Website A5200, A9270, B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9000, B9002, B9998, E0776 BA, BO, EY
External Breast ProsthesesExternal Website A4280, L8000, L8001, L8002, L8010, L8015, L8020, L8030, L8031, L8032, L8035, L8039 EY, LT, RT
External Infusion PumpsExternal Website Group 1 Equipment:
E0776, E0799, E0780, E0781, E0784, E0791, E1399, K0455
Group 2 Supplies:
A4221, A4222, A4223, A4305, A4306, A9270, A9274, K0552, K0601, K0602, K0603, K0604, K0605
Group 3 Drugs:
J0133, J0285, J0287, J0288, J0289, J0895, J1170, J1250, J1265, J1325, J1455, J1457, J1559, J1561, J1562, J1569, J1570, J1817, J2175, J2260, J2270, J2271, J2275, J2278, J3010, J3285, J7799, J9000, J9040, J9065, J9100, J9190, J9200, J9360, J9370
EY, GA, GY, GZ, JB, KX
Eye ProsthesesExternal Website L9900, V2623, V2624, V2625, V2626, V2627, V2628, V2629 EY, LT, RT
Facial ProsthesesExternal Website A4364, A4450, A4452, A4455, A4456, A5120, L8040, L8041, L8042, L8043, L8044, L8045, L8046, L8047, L8048, L8049, V2623, V2629 AV, EY, KM, KN, LT, RT
Glucose MonitorsExternal Website Group 1 Equipment:
E0607, E0620, E2100, E2101
Group 2 Accessories/Supplies:
A4233, A4234, A4235, A4236, A4244, A4245, A4246, A4247, A4250, A4253, A4255, A4256, A4257, A4258, A4259, A9275, A9276, A9277, A9278
EY, KS, KX
Heating Pads and Heat LampsExternal Website A9273, A9999, E0200, E0205, E0210, E0215, E0217, E0225, E0236, E0239, E0249, E1399 EY
High Frequency Chest Wall Oscillation DevicesExternal Website A7025, A7026, E0483 EY, GA, GZ, KX
Hospital Beds And AccessoriesExternal Website Group 1 Fixed Height Beds:
E0250, E0251, E0290, E0291, E0328
Group 2 Variable Height Beds:
E0255, E0256, E0292, E0293
Group 3 Semi-Electric Beds:
E0260, E0261, E0294, E0295, E0329
Group 4 Total Electric Beds:
E0265, E0266, E0296, E0297
Group 5 Heavy Duty Beds:
E0301, E0302, E0303, E0304
Group 6 Accessories:
E0271, E0272, E0273, E0274, E0280, E0305, E0310, E0315, E0316, E0910, E0911, E0912, E0940
Group 7 Miscellaneous:
E1399
EY, GA, GK, GL, GZ, KX
Immunosuppressive DrugsExternal Website J0485, J2920, J2930, J7500, J7501, J7502, J7504, J7505, J7506, J7507, J7508, J7509, J7510, J7511, J7513, J7515, J7516, J7517, J7518, J7520, J7525, J7527, J7599, J8530, J8610, Q0510, Q0511, Q0512 EY, GY, KX
Infrared Heating Pad SystemsExternal Website Group 1 Equipment:
E0221
Group 2 Accessories:
A4639
EY
Intrapulmonary Percussive Ventilation SystemExternal Website E0481 EY
Intravenous Immune GlobulinExternal Website A4223, J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1573, J1599, J2791 EY
Knee OrthosesExternal Website A4466, A9270, K0672, K0901, K0902, L1810, L1812, L1820, L1830, L1831, L1832, L1833, L1834, L1836, L1840, L1843, L1844, L1845, L1846, L1847, L1848, L1850, L1860, L2275, L2320, L2330, L2385, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2750, L2755, L2780, L2785, L2795, L2800, L2810, L2820, L2830, L2999, L4002, L4205, L4210, L9900 EY, GA, GZ, KX, LT, RT
Lower Limb ProsthesesExternal Website L5000, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5160, L5200, L5210, L5220, L5230, L5250, L5270, L5280, L5301, L5312, L5321, L5331, L5341, L5400, L5410, L5420, L5430, L5450, L5460, L5500, L5505, L5510, L5520, L5530, L5535, L5540, L5560, L5570, L5580, L5585, L5590, L5595, L5600, L5610, L5611, L5613, L5614, L5616, L5617, L5618, L5620, L5622, L5624, L5626. L5628, L5629, L5630, L5631, L5632, L5634, L5636, L5637, L5638, L5639, L5640, L5642, L5643, L5644, L5645, L5646, L5647, L5648, L5649, L5650, L5651, L5652, L5653, L5654, L5655, L5656, L5658, L5661, L5665, L5666, L5668, L5670, L5671, L5672, L5673, L5676, L5677, L5678, L5679, L5680, L5681, L5682, L5683, L5684, L5685, L5686, L5688, L5690, L5692, L5694, L5695, L5696, L5697, L5698, L5699, L5700, L5701, L5702, L5703, L5704, L5705, L5706, L5707, L5710, L5711, L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5781, L5782, L5785, L5790, L5795, L5810, L5811, L5812, L5814, L5816, L5818, L5822, L5824, L5826, L5828, L5830, L5840, L5845, L5848, L5850, L5855, L5856, L5857, L5858, L5859, L5910, L5920, L5925, L5930, L5940, L5950, L5960, L5961, L5962, L5964, L5966, L5968, L5969, L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979, L5980, L5981, L5982, L5984, L5985, L5986, L5987, L5988, L5990, L5999, L7367, L7368, L7510, L7520, L7600, L8400, L8410, L8417, L8420, L8430, L8440, L8460, L8470, L8480 EY, K0, K1, K2, K3, K4, LT, RT
Manual Wheelchair BasesExternal Website E1037, E1038, E1039, E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009 EY, GA, GY, GZ, KX
Mechanical In-exsufflation DevicesExternal Website A7020, E0482 EY
NebulizersExternal Website Group 1 Equipment:
E0565, E0570, E0572, E0574, E0575, E0585, K0730
Group 2 Accessories:
A4619, A7003, A7004, A7005, A7006, A7007, A7008, A7009, A7010, A7011, A7012, A7013, A7014, A7015, A7016, A7017, A7525, E0580, E1372
Group 3 Inhalation Drugs & Solutions:
A4216, A4217, A4218, A7018, G0333, J2545, J7604, J7605, J7606, J7607, J7608, J7609, J7610, J7611, J7612, J7613, J7614, J7615, J7620, J7622, J7624, J7626, J7627, J7628, J7629, J7631, J7632, J7634, J7635, J7636, J7637, J7638, J7639, J7640, J7641, J7642, J7643, J7644, J7645, J7647, J7650, J7657, J7660, J7669, J7670, J7676, J7680, J7681, J7682, J7683, J7684, J7685, J7686, J7699, Q0513, Q0514, Q4074
EY, GA, GZ, KO, KP, KQ, KX
Negative Pressure Wound Therapy PumpsExternal Website Group 1 Equipment:
E2402
Group 2 Supplies:
A6550, A7000
EY, GA, GZ, KX
Oral Anticancer DrugsExternal Website A9270, J8498, J8597, J8999, Q0511, Q0512 EY    
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)External Website J8501, J8540, J8650, Q0161, Q0162, Q0163, Q0164, Q0166, Q0167, Q0169,  Q0173, Q0174, Q0175, Q0177, Q0180, Q0181, Q0511, Q0512 EY, GA, GZ, KX
Oral Appliances for Obstructive Sleep ApneaExternal Website A9270, E0485, E0486, E1399 EY, GA, GZ, KX
Orthopedic FootwearExternal Website A9283, L3000, L3001, L3002, L3003, L3010, L3020, L3030, L3031, L3040, L3050, L3060, L3070, L3080, L3090, L3100, L3140, L3150, L3160, L3170, L3201, L3202, L3203, L3204, L3206, L3207, L3208, L3209, L3211, L3212, L3213, L3214, L3215, L3216, L3217, L3219, L3221, L3222, L3224, L3225, L3230, L3250, L3251, L3252, L3253, L3254, L3255, L3257, L3260, L3265, L3300, L3310, L3320, L3330, L3332, L3334, L3340, L3350, L3360, L3370, L3380, L3390, L3400, L3410, L3420, L3430, L3440, L3450, L3455, L3460, L3465, L3470, L3480, L3485, L3500, L3510, L3520, L3530, L3540, L3550, L3560, L3570, L3580, L3590, L3595, L3600, L3610, L3620, L3630, L3640, L3649 EY, GY, KX, LT, RT
Osteogenesis StimulatorsExternal Website Group 1 Equipment:
E0747, E0748, E0760
Group 2 Supplies:
A4559
EY, KF
Ostomy SuppliesExternal Website A4331, A4357, A4361, A4362, A4363, A4364, A4366, A4367, A4368, A4369, A4371, A4372, A4373, A4375, A4376, A4377, A4378, A4379, A4380, A4381, A4382, A4383, A4384, A4385, A4387, A4388, A4389, A4390, A4391, A4392, A4393, A4394, A4395, A4396, A4397, A4398, A4399, A4402, A4404, A4405, A4406, A4407, A4408, A4409, A4410, A4411, A4412, A4413, A4414, A4415, A4416, A4417, A4418, A4419, A4420, A4421, A4422, A4423, A4424, A4425, A4426, A4427, A4428, A4429, A4430, A4431, A4432, A4433, A4434, A4435, A4450, A4452, A4455, A4456, A5051, A5052, A5053, A5054, A5055, A5056, A5057, A5061, A5062, A5063, A5071, A5072, A5073, A5081, A5082, A5083, A5093, A5102, A5120, A5121, A5122, A5126, A5131, A6216, A9270 AU, EY
Oxygen and Oxygen EquipmentExternal Website Group 1 Equipment:
E0424, E0425, E0430, E0431, E0433, E0434, E0435, E0439, E0440, E0441, E0442, E0443, E0444, E0445, E0446, E1390, E1391, E1392, E1405, E1406, K0738
Group 2 Accessories:
A4575, A4606, A4608, A4615, A4616, A4617, A4619, A4620, A7525, A9900, E0455, E0555, E0580, E1352, E1353, E1354, E1355, E1356, E1357, E1358
EY, Q0, QE, QF, QG, QH, RA
Parenteral NutritionExternal Website B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200, B9004, B9006, B9999, E0776 BA, EY
Patient LiftsExternal Website E0621, E0625, E0630, E0635, E0636, E0639, E0640, E1035, E1036 EY, GA, GZ, KX
Pneumatic Compression DevicesExternal Website E0650, E0651, E0652, E0655, E0656, E0657, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673 EY
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep ApneaExternal Website

Group 1 Equipment:
E0470, E0471, E0601
Group 2 Accessories:
A4604, A7027, A7028, A7029, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0561, E0562

EY, GA, GZ, KX
Power Mobility DevicesExternal Website E0983, E0984, E0986, K0013, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898, K0899 EY, GA, GY, GZ, KX
Pressure Reducing Support Surfaces - Group 1External Website A4640, A9270, E0181, E0182, E0184, E0185, E0186, E0187, E0188, E0189, E0196, E0197, E0198, E0199, E1399 EY, GA, GZ, KX  
Pressure Reducing Support Surfaces - Group 2External Website E0193, E0277, E0371, E0372, E0373, E1399 EY, GA, GZ, KX
Pressure Reducing Support Surfaces - Group 3External Website E0194 EY, GA, GZ, KX
Refractive LensesExternal Website Group 1 Frames:
V2020, V2025
Group 2 Eyeglass Lenses:
V2100, V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299, V2300, V2301, V2302, V2303, V2304, V2305, V2306, V2307, V2308, V2309, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399, V2410, V2430, V2499
Group 3 Contact Lenses:
V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599
Group 4 Low Vision Aids:
V2600, V2610, V2615
Group 5 Miscellaneous:
V2700, V2702, V2710, V2715, V2718, V2730, V2744, V2745, V2750, V2755, V2756, V2760, V2761, V2762, V2770, V2780, V2781, V2782, V2783, V2784, V2876, V2797, V2799
EY, GA, GY, GZ, KX, LT, RT
Respiratory Assist DevicesExternal Website Group 1 Equipment:
E0470, E0471
Group 2 Accessories:
A4604, A7027, A7028, A7029,A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0561, E0562
EY, GA, GZ, KX
Seat Lift MechanismsExternal Website E0172, E0627, E0628, E0629 EY
Speech Generating DevicesExternal Website E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599 EY, GA, GZ, KX
Spinal Orthoses: TLSO and LSOExternal Website A4466, A9270, L0450, L0452, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490, L0491, L0492, L0621, L0623, L0625, L0626, L0627, L0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0641, L0642, L0643, L0648, L0649, L0650, L0651, L0984, L4002 CG, EY
Suction PumpsExternal Website A4216, A4217, A4605, A4624, A4628, A7000, A7001, A7002, A7047, A9272, E0600, E2000, K0743, K0744, K0745, K0746 EY
Surgical DressingsExternal Website A4450, A4452, A4461, A4463, A4465, A4490, A4495, A4500, A4510, A4649, A6010, A6011, A6021, A6022, A6023, A6024, A6025, A6154, A6196, A6197, A6198, A6199, A6203, A6204, A6205, A6206, A6207, A6208, A6209, A6210, A6211, A6212, A6213, A6214, A6215, A6216, A6217, A6218, A6219, A6220, A6221, A6222, A6223, A6224, A6228, A6229, A6230, A6231, A6232, A6233, A6234, A6235, A6236, A6237, A6238, A6239, A6240, A6241, A6242, A6243, A6244, A6245, A6246, A6247, A6248, A6250, A6251, A6252, A6253, A6254, A6255, A6256, A6257, A6258, A6259, A6260, A6261, A6262, A6266, A6402, A6403, A6404, A6407, A6410, A6411, A6412, A6413, A6441, A6442, A6443, A6444, A6445, A6446, A6447, A6448, A6449, A6450, A6451, A6452, A6453, A6454, A6455, A6456, A6457, A6501, A6502, A6503, A6504, A6505, A6506, A6507, A6508, A6509, A6510, A6511, A6512, A6513, A6530, A6531, A6532, A6533, A6534, A6535, A6536, A6537, A6538, A6539, A6540, A6541, A6544, A6545, A6549, A9270 A1, A2, A3, A4, A5, A6, A7, A8, A9, AW, EY, GY, LT, RT
Therapeutic Shoes for Persons with DiabetesExternal Website A5500, A5501, A5503, A5504, A5505, A5506, A5507, A5508, A5510, A5512, A5513 EY, GA, GY, GZ, KX, LT, RT
Tracheostomy Care SuppliesExternal Website A4364, A4402, A4450, A4452, A4456, A4481, A4623, A4625, A4626, A4629, A5120, A7501, A7502, A7503, A7504, A7505, A7506, A7507, A7508, A7509, A7520, A7521, A7522, A7523, A7524, A7526, A7527 AU, EY
Transcutaneous Electrical Nerve Stimulators (TENS)External Website Group 1 Equipment:
E0720, E0730, E0731
Group 2 Supplies:
A4557, A4595
EY, GA, GZ, KX, Q0
Urological SuppliesExternal Website A4217, A4310, A4311, A4312, A4313, A4314, A4315, A4316, A4320, A4321, A4322, A4326, A4327, A4328, A4331, A4332, A4333, A4334, A4335, A4336, A4338, A4340, A4344, A4346, A4349, A4351, A4352, A4353, A4354, A4355, A4356, A4357, A4358, A4360, A4402, A4450, A4452, A4455, A4456, A4520, A4554, A5102, A5105, A5112, A5113, A5114, A5131, A5200, A9270 AU, EY, GA, GY, GZ, KX
WalkersExternal Website A4636, A4637, A9270, A9900, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158, E0159, E1399 EY, GA, GY, GZ, KX
Wheelchair Options/AccessoriesExternal Website Group 1 Arm of chair:
E0973, E2209, K0015, K0017, K0018, K0019, K0020
Group 2 Foot rest/Leg rest:
E0951, E0952, E0990, E0995, E1020, K0037, K0038, K0039, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K1095
Group 3 Non-standard seat frame dimensions:
E1011, E2201, E2202, E2203, E2204, K0056
Group 4 Rear wheels for manual wheelchairs:
E0961, E0967, E0988, E2205, E2206, E2211, E2212, E2213, E2214, E2215, E2216, E2217, E2218, E2218, E2219, E2220, E2221, E2222, E2224, E2225, E2226, E2227, E2228, K0065, K0069, K0070, K0071, K0072, K0073, K0077
Group 5 Batteries/Chargers:
E2358, E2359, E2360, E2361, E2362, E2363, E2364, E2365, E2366, E2367, E2371, E2372, E2397, K0733
Group 6 Power Seating Systems:
E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1009, E1010, E2300, E2301, E2310, E2311
Group 7 Power Wheelchair Drive Control Systems:
E2312, E2313, E2321, E2322, E2323, E2324, E2325, E2326, E2327, E2328, E2329, E2330, E2331, E2373, E2374, E2375, E2376, E2377
Group 8 Other Power Wheelchair Accessories:
E1016, E1018, E2351, E2368, E2369, E2370, E2378, E2381, E2382, E2383, E2384, E2385, E2386, E2387, E2388, E2389, E2390, E2391, E2392,E 2394, E2395, E2396, K0098
Group 9 Miscellaneous Accessories:
A9270, A9900, E0705, E0950, E0958, E0959, E0971, E0974, E0978, E0981, E0982, E0985, E1014, E1015, E1017, E1028, E1029, E1030, E1225, E1226, E2207, E2208, E2210, E2230, E2295, K0105, K0108
EY, GA, GY, GZ, KC, KX, RB
Wheelchair SeatingExternal Website Group 1 Seat cushions:
E2601, E2602, E2603, E2604, E2605, E2606, E2607, E2608, E2609, E2610, E2622, E2623, E2624, E2625
Group 2 Back Cushions:
E2611, E2612, E2613, E2614, E2615, E2616, E2617, E2620, E2621
Group 3 Positioning Accessories:
E0955, E0956, E0957, E0960, E0966, E1028
Group 4 Miscellaneous:
A9900, E0992, E2231, E2291, E2292, E2293, E2294, E2619, K0108, K0669
EY, GA, GY, GZ, KX

Updated: 10.13.14