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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

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 Orthosis 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 Defibrillators A9999, E0617, K0606, K0607, K0608, K0609 EY, GA, GZ, KF, KX
Canes and Crutches A4635, A4636, A4637, A9270, E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116, E0117, E0118, E0153 EY
Cervical Traction Devices E0840, E0849, E0850, E0855, E0856, E0860 EY, GA, GZ, KX
Cold Therapy A9270, A9273, E0218 EY
Commodes E0163, E0165, E0167, E0168, E0170, E0171, E0172, E0175, E0244 EY, GA, GY, GZ, KX
Enteral Nutrition 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 Prostheses A4280, L8000, L8001, L8002, L8010, L8015, L8020, L8030, L8031, L8032, L8035, L8039 EY, LT, RT
External Infusion Pumps 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
Eye Prostheses L9900, V2623, V2624, V2625, V2626, V2627, V2628, V2629 EY, LT, RT
Facial Prostheses 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 Monitors 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
Heating Pads and Heat Lamps A9273, A9999, E0200, E0205, E0210, E0215, E0217, E0225, E0236, E0239, E0249, E1399 EY
High Frequency Chest Wall Oscillation Devices A7025, A7026, E0483 EY, GA, GZ, KX
Hospital Beds And Accessories 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:
Immunosuppressive Drugs 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 Systems Group 1 Equipment:
Group 2 Accessories:
Intrapulmonary Percussive Ventilation System E0481 EY
Intravenous Immune Globulin A4223, J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1573, J1599, J2791 EY
Knee Orthoses A4466, A9270, K0672, 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 Prostheses 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 Bases 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 Devices A7020, E0482 EY
Nebulizers 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
Negative Pressure Wound Therapy Pumps Group 1 Equipment:
Group 2 Supplies:
A6550, A7000
Oral Anticancer Drugs A9270, J8498, J8597, J8999, Q0511, Q0512 EY    
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) 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 Apnea A9270, E0485, E0486, E1399 EY, GA, GZ, KX
Orthopedic Footwear 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 Stimulators Group 1 Equipment:
E0747, E0748, E0760
Group 2 Supplies:
Ostomy Supplies 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 Equipment 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 Nutrition 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 Lifts E0621, E0625, E0630, E0635, E0636, E0639, E0640, E1035, E1036 EY, GA, GZ, KX
Pneumatic Compression Devices 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 Apnea

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

Power Mobility Devices 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 1 A4640, A9270, E0181, E0182, E0184, E0185, E0186, E0187, E0188, E0189, E0196, E0197, E0198, E0199, E1399 EY, GA, GZ, KX  
Pressure Reducing Support Surfaces - Group 2 E0193, E0277, E0371, E0372, E0373, E1399 EY, GA, GZ, KX
Pressure Reducing Support Surfaces - Group 3 E0194 EY, GA, GZ, KX
Refractive Lenses 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
Respiratory Assist Devices 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
Seat Lift Mechanisms E0172, E0627, E0628, E0629 EY
Speech Generating Devices E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599 EY, GA, GZ, KX
Spinal Orthoses: TLSO and LSO 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 Pumps A4216, A4217, A4605, A4624, A4628, A7000, A7001, A7002, A7047, A9272, E0600, E2000, K0743, K0744, K0745, K0746 EY
Surgical Dressings 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 Diabetes A5500, A5501, A5503, A5504, A5505, A5506, A5507, A5508, A5510, A5512, A5513 EY, GA, GY, GZ, KX, LT, RT
Tracheostomy Care Supplies 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) Group 1 Equipment:
E0720, E0730, E0731
Group 2 Supplies:
A4557, A4595
EY, GA, GZ, KX, Q0
Urological Supplies 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
Walkers 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/Accessories 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
Wheelchair Seating 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