LCDs / Medical Policies
A Local Coverage Determination (LCD), as defined in §1869(f)(2)(B) of the Social Security Act (SSA), is a Medicare Administrative Contractor's (MAC's) determination as to whether a particular item or service is covered on a contractor–wide basis in accordance with section 1862(a)(1)(A) of the Act.
Reference the CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 13 for details about the LCD process.
- LCD/Medical Policies Stakeholder Meetings
- Request a New LCD
- Request a Revision to an Active LCD
- Submit Draft LCD Comments
How to Find CGS J15 LCDs & Articles
NOTE: CMS and MACs don't develop an NCD and/or LCD for each item or service that Medicare covers. In the absence of a national/local coverage policy, reference the Social Security Act, CMS Medicare Benefit Policy Manual (Pub. 100-02), Code of Federal Regulations, and/or other CMS/CGS resources for coverage guidance.
- Search the Medicare Coverage Database (MCD) (includes all national/local coverage policy related document types) or the MCD Archive (contains outdated (no longer in effect) LCDs and articles). See the How to Use the Medicare Coverage Database MLN educational tool for details.
- Use the direct links to CGS J15 active and future LCDs and articles provided in the table below (listed alphabetically by title).
- Download a copy of the table below in Excel spreadsheet format (Revised 09.23.24) for additional sort and filter capabilities.
ID | Title | Effective Date | Revision Effective Date | Last Updated | Status | HCPCS/CPT Code | Article(s) |
---|---|---|---|---|---|---|---|
L32553 | Allergy Immunotherapy | 10/1/15 | 11/2/23 | 10/27/23 | Active | 95115, 95117, 95144, 95145, 95146, 95147, 95148, 95149, 95165, 95170, 95180, 95199 | A56424 – Billing and Coding: Allergy Immunotherapy |
L39434 | Allogenic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin | 2/19/23 | 6/6/24 | 3/7/24 | Active | 38240 | A59215 – Billing and Coding: Allogenic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin |
L39575 | Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound | 12/10/23 | N/A | N/A | Active | Q4139, Q4145, Q4155, Q4162, Q4168, Q4171, Q4174, Q4177, Q4185, Q4189, Q4192, Q4206, Q4212, Q4213, Q4215, Q4230, Q4231, Q4233, Q4240, Q4241, Q4242, Q4244, Q4245, Q4246 | A59374 – Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound |
N/A | ArgusM II Retinal Prosthesis System | 10/1/15 | 11/16/23 | 11/7/23 | Active | L8608, 0100T | A54327 – Billing and Coding: ArgusM II Retinal Prosthesis System |
L39840 | Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) | 11/24/24 | N/A | N/A | Future | 0623T, 0624T, 0625T, 0626T | A59716 – Billing and Coding: Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) |
L36975 | Bladder/Urothelial Tumor Markers | 3/6/17 | 2/1/24 | 1/25/24 | Active | 86294, 86316, 86386, 88120, 88121 | A56471 – Billing and Coding: Bladder / Urothelial Tumor Markers |
L33944 | Blepharoplasty | 10/1/15 | 11/2/23 | 10/27/23 | Active | Group 1: 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924 Group 2: 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908 |
A56439 – Billing and Coding: Blepharoplasty |
L36460 | Bone Mass Measurement | 2/1/16 | 1/4/24 | 12/29/23 | Active | 76977, 77078, 77080, 77081, 77085, 78350, 78351, G0130, 0554T, 0555T, 0556T, 0557T, 0558T | A57132 – Billing and Coding: Bone Mass Measurement |
L33949 | Botulinum Toxins | 10/1/15 | 12/7/23 | 3/6/24 | Active | Group 1: 31573, 43201, 43236, 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 67345 Group 2: C9399, J0585, J0586, J0587, J0588, J3590 |
A56472 – Billing and Coding: Botulinum Toxins |
L33950 | Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography | 10/1/15 | 12/7/23 | 11/29/23 | Active | 19030, 76641, 76642, 77046, 77047, 77048, 77049, 77053, 77054, 77063, 77065, 77066, 77067, C8903, C8905, C8906, C8908, G0279 | A56448 – Billing and Coding: Breast Imaging Mammography / Breast Echography (Sonography) / Breast MRI / Ductography |
L33943 | B-type Natriuretic Peptide (BNP) Testing | 10/1/15 | 12/7/23 | 11/29/23 | Active | 83880 | A56425 – Billing and Coding: B-type Natriuretic Peptide (BNP) Testing |
L33946 | Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy | 10/1/15 | 11/2/23 | 10/27/23 | Active | 66820, 66821 | A56493 – Billing and Coding: Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy |
L33959 | Cardiac Catheterization and Coronary Angiography | 10/1/15 | 11/2/23 | 10/27/23 | Active | Group 1: 92978, 92979, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93464, 93503, 93505, 93563, 93564, 93565, 93566, 93567, 93568, 93571, 93572, 93593, 93594, 93595, 93596, 93597, 93598, G0269 Group 2: 36140, 36200, 36215, 36216, 36217, 36218, 36221, 36222, 36223, 36224, 36225, 36226, 36227, 36228, 36245, 36246, 36247, 36248, 75625, 75630, 75635, 75705, 75710, 75716 Group 3: G0278 |
A56500 – Billing and Coding: Cardiac Catheterization and Coronary Angiography |
L33947 | Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) | 10/1/15 | 10/3/24 | 9/27/24 | Active | 75571, 75572, 75573, 75574 | A56451 – Billing and Coding: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) |
L33952 | Cardiac Event Detection | 10/1/15 | 12/7/23 | 11/29/23 | Active | 93228, 93229, 93268, 93270, 93271, 93272, 93799 | A56452 – Billing and Coding: Cardiac Event Detection |
L33960 | Cardiovascular Nuclear Medicine | 10/1/15 | 2/1/24 | 1/25/24 | Active | 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78496, 93015, 93016, 93017, 93018, A9500, A9501, A9502, A9505, A9512, A9538, A9560, J0153, J1245, J1250, J2785, J3490 | A56494 – Billing and Coding: Cardiovascular Nuclear Medicine |
L33954 | Cataract Extraction | 10/1/15 | 1/4/24 | 12/29/23 | Active | 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984 | A56453 – Billing and Coding: Cataract Extraction |
L33945 | Cerumen (Earwax) Removal | 10/1/15 | 2/1/24 | 1/25/24 | Active | 69209, 69210, G0268 | A56454 – Billing and Coding: Cerumen (Earwax) Removal |
L39741 | Cervical Fusion | 7/7/2024 | N/A | N/A | Active | 22548, 22551, 22552, 22554, 22590, 22595, 22600, 22800, 22802, 22808, 22810, 22812 | A59608 – Billing and Coding: Cervical Fusion |
L37254 | Chiropractic Services | 11/6/17 | 2/1/24 | 1/25/24 | Active | 98940, 98941, 98942 | A56455 – Billing and Coding: Chiropractic Services |
N/A | Clinical Trials – Medical Policy Article | 10/1/15 | 11/16/23 | 11/7/23 | Active | N/A | A52430 – Clinical Trials – Medical Policy Article |
L37126 | Coenzyme Q10 (CoQ10) | 7/10/17 | 2/1/24 | 1/25/24 | Active | 82542 | A55715 – Billing and Coding: Coenzyme Q10 (CoQ10) |
L38777 | Colon Capsule Endoscopy (CCE) | 3/29/21 | 1/30/22 | 12/10/21 | Active | N/A | A58362 – Billing and Coding: Colon Capsule Endoscopy |
L34005 | Colonoscopy/Sigmoidoscopy/ Proctosigmoidoscopy | 10/1/15 | 2/1/24 | 1/25/24 | Active | 44388, 44389, 44390, 44391, 44392, 44394, 44401, 44402, 45300, 45303, 45305, 45307, 45308, 45309, 45315, 45317, 45320, 45321, 45327, 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45340, 45341, 45342, 45346, 45347, 45378, 45379, 45380, 45381, 45382, 45384, 45385, 45386, 45388, 45389, 45391, 45392, 45399 | A56456 – Billing and Coding: Colonoscopy / Sigmoidoscopy / Proctosigmoidoscopy |
L38694 | Computed Tomography Cerebral Perfusion Analysis (CTP) | 6/17/21 | 6/17/21 | 5/30/24 | Active | 0042T | A58218 – Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) |
L34008 | Computerized Corneal Topography | 10/1/15 | 2/1/24 | 1/25/24 | Active | 92025 | A56816 – Billing and Coding: Computerized Corneal Topography |
L33999 | Corneal Pachymetry | 10/1/15 | 2/1/24 | 1/25/24 | Active | 76514 | A56457 – Billing and Coding: Billing and Coding for Corneal Pachymetry |
L39506 | Cosmetic and Reconstructive Surgery | 5/28/23 | N/A | 4/6/23 | Active | Group 1: 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19368, 19369, 19370, 19371, 19380, 19396 Group 2: 19318 Group 3: 19300 Group 4: 11920, 11921, 11922 Group 5: 15775, 15776 Group 6: 30400-30450, 30460, 30462, 30520 Group 7: 15788-15793 Group 8: 15830, 15847, 15877 Group 9: G0429, Q2026, Q2028 Group 10: 15828, 15829 Group 11: 11950-11954, 15780, 15782, 15783, 15819, 15824-15826, 15832-15839, 15876, 15878, 15879, 17340, 17360, 17380, 69300 |
A59299 – Billing and Coding: Cosmetic and Reconstructive Surgery |
L37598 | Cystatin C Measurement | 12/17/18 | 1/4/24 | 12/29/23 | Active | 82610 | A56988 – Billing and Coding: Cystatin C Measurement |
L34032 | Debridement Services | 10/1/15 | 10/3/24 | 9/27/24 | Active | 11000, 11001, 11042, 11043, 11044, 11045, 11046, 11047 | A56459 – Billing and Coding: Debridement Services |
L34062 | Dialysis Access Maintenance | 10/1/15 | 2/1/24 | 1/25/24 | Active | 36005, 36010, 36140, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36593, 36831, 36832, 36833, 36901, 36902, 36903, 36904, 36905, 36906, 36907, 37186, 37211, 37212, 37213, 37214, 37236, 37237, 37246, 37247, 37248, 37249, 75710, 75820, 75822, 75825, 75827, 93990 | A56460 – Billing and Coding: Dialysis Access Maintenance |
L38992 | Electroretinography (ERG) | 1/30/22 | 1/12/23 | 1/4/23 | Active | 92273, 92274, 0509T | A58706 – Billing and Coding: Electroretinography (ERG) |
L34081 | Endoscopy by Capsule | 10/1/15 | 3/7/24 | 2/28/24 | Active | Group 1: 91110 Group 2: 91111, 91299 |
A56461 – Billing and Coding: Endoscopy by Capsule |
L39015 | Epidural Steroid Injections for Pain Management | 12/5/21 | 11/9/23 | 10/31/23 | Active | Group 1: 62321, 62323, 64479, 64480, 64483, 64484 Group 2: 62320, 62322 |
A58731 – Billing and Coding: Epidural Steroid Injections for Pain Management |
L34356 | Erythropoiesis Stimulating Agents (ESA) | 10/1/15 | 3/7/24 | 2/29/24 | Active | J0881, J0882, J0885, J0890. Q4081, Q5105, Q5106 | A56462 – Billing and Coding: Erythropoiesis Stimulating Agents (ESA) |
L38773 | Facet Joint Interventions for Pain Management | 5/2/21 | 7/9/24 | 7/7/24 | Active | Group 1 64490, 64491, 64493, 64494, 64633, 64634, 64635, 64636 Group 2 64492, 64495, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0219T, 0220T, 0221T, 0222T |
A58364 – Billing and Coding: Facet Joint Interventions for Pain Management |
N/A | FDA Approved CLL Companion Diagnostic Test | 6/5/18 | 2/1/24 | 1/25/24 | Active | 88271, 88275, 88291, 88374, 88377 | A56050 – Billing and Coding: FDA Approved CLL Companion Diagnostic Test |
L34037 | Flow Cytometry | 10/1/15 | 3/7/24 | 2/29/24 | Active | Group 1: 88182, 88184, 88185, 88187, 88188, 88189 Group 2: 86355, 86356, 86357, 86359, 86360, 86361, 86367 |
A56464 – Billing and Coding: Flow Cytometry |
L38378 | Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH) | 4/1/20 | 4/4/24 | 3/29/24 | Active | C2596, 0421T | A57926 – Billing and Coding: Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH) |
L37364 | Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) | 1/7/19 | 4/4/24 | 3/29/24 | Active | Group 1: 87505, 87506 Group 2: 87507 |
A56596 – Billing and Coding: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) |
L37575 | Frequency of Hemodialysis | 4/1/19 | 3/7/24 | 2/29/24 | Active | 90999 | A56159 – Billing and Coding: Frequency of Hemodialysis |
L36906 | GlycoMark® Testing for Glycemic Control | 3/6/17 | 4/4/24 | 3/29/24 | Active | 84378, 84999 | A56465 – Billing and Coding: GlycoMark® Testing for Glycemic Control |
L38307 | Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea | 4/1/20 | 3/7/24 | 2/29/24 | Active | 64582 | A57149 – Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea |
L38268 | Immune Thrombocytopenia (ITP) Therapy | 4/1/20 | 3/7/24 | 2/29/24 | Active | 38100, 38120, 90283, J1459, J1460, J1556, J1557, J1560, J1561, J1566, J1568, J1569, J1572, J1599, J2788, J2790, J2791, J2792, J2796, J8499, J9312 | A57160 – Billing and Coding: Immune Thrombocytopenia (ITP) Therapy |
N/A | Implantable Automatic Defibrillators | 1/1/21 | 11/22/23 | 11/16/23 | Active | 33202, 33203, 33215, 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, G0448 | A57994 – Billing and Coding: Implantable Automatic Defibrillators |
L38662 | Implantable Continuous Glucose Monitors (I-CGM) | 11/2/20 | 11/4/24 | 9/27/24 | Active | 0446T, 0447T, 0448T | A58127 – Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) |
N/A | Influenza Diagnostic Test | 7/1/21 | 11/16/23 | 11/7/23 | Active | 87252, 87253, 87254, 87275, 87276, 87400, 87501, 87502, 87503, 87804 | A58817 – Billing and Coding: Influenza Diagnostic Tests |
N/A | Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach (0192T 66183) | 10/1/15 | 11/16/23 | 11/7/23 | Active | 66183 | A52432 – Billing and Coding: Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach (0192T 66183) |
L35891 | Intravenous Immune Globulin | 10/1/15 | 4/4/24 | 3/29/24 | Active | J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572 | A56779 – Billing and Coding: Intravenous Immune Globulin |
L34090 | Laser Ablation of the Prostate | 10/1/15 | 4/4/24 | 3/29/24 | Active | 52647, 52648, 52649 | A56467 – Billing and Coding: Laser Ablation of the Prostate |
N/A | Low frequency, non-contact, non-thermal ultrasound (CPT code 97610) | 11/1/18 | 3/7/24 | 2/29/24 | Active | 11042, 11043, 11044, 11045, 11046, 11047, 97597, 97598, 97602, 97607, 97608, 97610 | A56175 – Low frequency, non-contact, non-thermal ultrasound (CPT code 97610) |
L37790 | Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor | 10/1/18 | 9/5/24 | 8/26/24 | Active | 0398T | A58323 – Billing and Coding: Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions |
L37608 | MDS FISH | 5/6/19 | 8/8/24 | 7/29/24 | Active | 88271, 88273, 88274, 88275, 88291 | A56926 – Billing and Coding: MDS FISH |
L37578 | Micro-Invasive Glaucoma Surgery (MIGS) | 3/19/18 | 11/17/24 | 9/27/24 | Future | Group 1: 66989, 66991 Group 2: 66183, 0449T, 0671T Group 3: 0253T, 0450T, 0474T, |
A56491 – Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) |
L36494 | Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint | 2/1/16 | 1/4/24 | 12/29/23 | Active | 27279 | A56535 – Billing and Coding: Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint |
L34195 | Mohs Micrographic Surgery | 10/1/15 | 5/9/24 | 4/30/24 | Active | 17311, 17312, 17313, 17314, 17315 | A56836 – Billing and Coding: Mohs Micrographic Surgery |
N/A | MolDX: Algorithm definition as a component of a laboratory test | 3/11/21 | 11/16/23 | 11/7/23 | Active | N/A | A58677 – MolDX: Algorithm definition as a component of a laboratory test |
L36139 | MolDX: Biomarkers in Cardiovascular Risk Assessment | 10/5/15 | 3/2/23 | 2/24/23 | Active | 81439, 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141 | A54685 – Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy (ARVD / C) Testing A57386 – Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment |
L38249 | MolDX: Blood Product Molecular Antigen Typing | 11/1/20 | 5/23/24 | 9/6/24 | Active | Group 1: 81403, 0001U, 0084U Group 2: 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0221U, 0222U |
A57155 – Billing and Coding: MolDX: Blood Product Molecular Antigen Typing |
L36425 | MolDX: Breast Cancer Assay: Prosigna® | 2/1/16 | 2/15/24 | 2/6/24 | Active | 81520 | A56989 – Billing and Coding: MolDX: Breast Cancer Assay: Prosigna® |
L37832 | MolDX: Breast Cancer Index® (BCI) Gene Expression Test | 4/1/19 | 11/2/23 | 10/27/23 | Active | 81518 | A56884 – Billing and Coding: MolDX: Breast Cancer Index™ (BCI) Gene Expression Test |
N/A | MolDX: Clarification of Order Requirements for Laboratory and Molecular Diagnostic services | 5/2/24 | N/A | N/A | Active | N/A | A59792 – MolDX: Clarification of Order Requirements for Laboratory and Molecular Diagnostic services |
L37130 | MolDX: DecisionDx-UM (Uveal Melanoma) | 7/10/17 | 5/18/23 | 5/8/23 | Active | 81552 | A56981 – Billing and Coding: MolDX: DecisionDx-UM (Uveal Melanoma) |
N/A | MolDX: Defining panel services in MolDX | 2/29/24 | N/A | 2/22/24 | Active | N/A | A59698 – MolDX: Defining panel services in MolDX |
L37356 | MolDX: EndoPredict Breast Cancer Gene Expression Test | 3/6/18 | 4/11/24 | 4/5/24 | Active | 81522 | A56997 – Billing and Coding: MolDX: EndoPredict Breast Cancer Gene Expression Test |
L37905 | MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic Test | 5/20/19 | 6/29/23 | 5/6/24 | Active | 81554 | A56985 – Billing and Coding: MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic Test |
L36117 | MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease | 10/5/15 | 5/16/24 | 5/6/24 | Active | 81206, 81207, 81208, 81479, 0040U 81170 81206, 81207, 81208, 81219, 81270, 81279, 81338, 81339 81450 81479, 0027U, 0040U |
A54686 – Billing and Coding: MolDX: BCR-ABL A56999 – Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease |
L35984 | MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) | 10/1/15 | 7/20/23 | 6/27/24 | Active | 81240, 81241, 81291 | A56980 – Billing and Coding: MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) |
L36485 | MolDX: HLA-DQB1*06:02 Testing for Narcolepsy | 2/15/16 | 9/19/24 | 9/14/24 | Active | 81383 | A56881 – Billing and Coding: MolDX: HLA-DQB1*06:02 Testing for Narcolepsy |
N/A | MolDX: HLA Testing for Transplant Histocompatibility | 8/15/19 | 11/16/23 | 11/10/23 | Active | 81370, 81371, 81372, 81373, 81375, 81376, 81378, 81379, 81380, 81382 | A56885 – Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility |
L37903 | MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer | 5/13/19 | 6/27/24 | 6/18/24 | Active | 81479, 0388U | A56982 – Billing and Coding: MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer |
L39017 | MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer | 8/21/22 | 4/18/24 | 4/12/24 | Active | Group 1: 81202, 81215, 81217, 81293, 81296, 81299, 81308, 81318, 81322, 81353, 81403, 81404, 81405, 81406, 81432, 81433, 81435, 81436, 81437, 81438, 81479, 0101U, 0102U, 0103U, 0129U Group 2: 81163, 81164, 81165, 81166, 81167, 81201, 81203, 81212, 81216, 81292, 81294, 81295, 81297, 81298, 81300, 81307, 81317, 81319, 81321, 81323, 81351 |
A54689 – Billing and Coding: Germline testing for use of PARP inhibitors A58734 – Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer |
L38016 | MolDX: Melanoma Risk Stratification Molecular Testing | 6/24/19 | 5/18/23 | 5/12/23 | Active | 81479, 81529, 81599 | A57165 – Billing and Coding: MolDX: Melanoma Risk Stratification Molecular Testing |
L36113 | MolDX: MGMT Promoter Methylation Analysis | 10/5/15 | 8/22/24 | 8/14/24 | Active | 81287 | A56983 – Billing and Coding: MolDX: MGMT Promoter Methylation Analysis |
L38822 | MolDX: Minimal Residual Disease Testing for Cancer | 12/26/21 | 11/2/23 | 10/27/23 | Active | Group 1: 81445, 81479, 0340U Group 2: 81479, 0422U Group 3: 81479,0356U Group 1: 81450, 81479 Group 2: 81479 Group 3: 81206, 81207, 81208, 81310, 81315, 81316, 81334, 81401, 81479, 0040U Group 4: 81261, 81263, 81264, 81340, 81342, 81450, 81479 |
A58434 – Billing and Coding: MolDX: Minimal Residual Disease Testing for Solid Tumor Cancers A58998 – Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers |
L39389 | MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma | 8/6/23 | 5/16/24 | 5/9/24 | Active | 81479, 0090U, 0314U | A59163 – Billing and Coding: MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma |
L39585 | MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma | 8/18/24 | N/A | N/A | Active | 81479, 0315U | A59382 – Billing and Coding: MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma |
L39427 | MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis | 10/15/23 | 8/22/24 | 8/23/24 | Active | 81599, 0456U | A59529 – Billing and Coding: MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis |
L39658 | MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate Pulmonary Nodules Following Bronchoscopy | 10/13/24 | N/A | N/A | Active | 81479 | A59482 – Billing and Coding: MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate Pulmonary Nodules Following Bronchoscopy |
L38997 | MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer | 7/17/22 | 3/14/24 | 3/6/24 | Active | Group 1: 0005U, 81313, 81479, 81551 Group 2: 0005U, 0339U |
A58713 – Billing and Coding: MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer |
L36021 | MolDX: Molecular Diagnostic Tests (MDT) | 10/1/15 | 8/22/24 | 8/14/24 | Active | See the Coding Information section in the article(s). | A54242 – Billing and Coding: MolDX: 9p21 Genotype Test A55716 – Billing and Coding: MolDX: Abbott RealTime IDH1 and IDH2 testing for Acute Myeloid Leukemia (AML) A54185 – Billing and Coding: MolDX: Afirma™ Assay by Veracyte Update A54244 – Billing and Coding: MolDX: ApoE Genotype A54188 – Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® A54257 – Billing and Coding: MolDX: BluePrint® Test A54189 – Billing and Coding: MolDX: cobas® EGFR Mutation Test Guidelines A54191 – Billing and Coding: MolDX: FDA-Approved BRAF Tests A54192 – Billing and Coding: MolDX: FDA-Approved EGFR Tests A54688 – Billing and Coding: MolDX: FDA-Approved KRAS Tests A54269 – Billing and Coding: MolDX: HTTLPR Gene Testing A54270 – Billing and Coding: MolDX: IKBKAP Genetic Testing A54271 – Billing and Coding: MolDX: Immunohistochemistry (IHC) Indications for Breast Pathology A54272 – Billing and Coding: MolDX: KIF6 Genotype A54274 – Billing and Coding: MolDX: L1CAM Gene Sequencing Guidelines A54194 – Billing and Coding: MolDX: MammaPrint A54278 – Billing and Coding: MolDX: MECP2 Genetic Testing A56106 – Billing and Coding: MolDX: Microsatellite Instability-High (MSI-H) and Mismatch Repair Deficient (dMMR) Biomarker for Patients with Unresectable or Metastatic Solid Tumors A56973 – Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) A54195 – Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay A54196 – Billing and Coding: MolDX: Oncotype DX® Colon Cancer Assay Update A54295 – Billing and Coding: MolDX: PIK3CA Gene Tests A54197 – Billing and Coding: MolDX: Progensa® PCA3 Assay Coverage Update A59646 – Billing and Coding: MolDX: Proteomics Testing A54300 – Billing and Coding: MolDx: SEPT9 Gene Test A54830 – Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268) A54283 – Billing and Coding: MolDX: SULT4A1 Genetic Testing A54901 – Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Next Generation Sequencing Testing in Cancer A54199 – Billing and Coding: MolDX: Therascreen® EGFR RGQ PCR Kit Guidelines A54200 – Billing and Coding: MolDX: therascreen® KRAS PCR Kit Guidelines |
L39038 | MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing | 7/16/22 | 4/25/24 | 4/18/24 | Active | Group 1: 87631, 87636, 87637, 87801, 0240U, 0241U Group 2: 87505 Group 3: 87483 Group 4: 87154 Group 5: 81513, 81514, 87800, 87801, 87999, 0352U, 0353U, 0402U Group 6: 87632, 87633, 87801, 87999, 0115U, 0202U, 0223U, 0225U Group 7: 87506, 87507 Group 8: 92 codes Groups 9-11: 87999 |
A58747 – Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing |
L39276 | MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia | 6/4/23 | 2/29/24 | 2/19/24 | Active | 81479, 0114U | A59051 – Billing and Coding: MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia |
L39650 | MolDX: Molecular Testing for Risk Stratification of Thyroid Nodules | 10/13/24 | N/A | N/A | Active | 81479, 81546 | A59474 – Billing and Coding: MolDX: Molecular Testing for Risk Stratification of Thyroid Nodules |
L38582 | MolDX: Molecular Testing for Solid Organ Allograft Rejection | 6/6/21 | 7/27/23 | 7/21/23 | Active | 81479, 81595, 81599, 0118U | A58061 – Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection |
L38067 | MolDX: Next-Generation Sequencing for Solid Tumors | 2/10/20 | 8/22/24 | 8/14/24 | Active | 81445, 81449, 81457, 81458, 81459, 81479, 0244U, 0250U, 0329U, 0334U, 0379U, 0391U | A57870 – Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors |
L38070 | MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies | 2/10/20 | 3/28/24 | 3/22/24 | Active | 81450, 81451, 81479 | A57873 – Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies |
L35442 | MolDX: NRAS Genetic Testing | 10/1/15 | 7/27/23 | 7/21/23 | Active | 81311, 81479 | A56998 – Billing and Coding: MolDX: NRAS Genetic Testing |
L36951 | MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) | 3/6/17 | 9/28/23 | 9/20/23 | Active | 0045U | A56887 – Billing and Coding: MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) |
L38394 | MolDX: Pharmacogenomics Testing | 8/3/20 | 8/24/23 | 8/14/23 | Active | 81225, 81226, 81227, 81231, 81232, 81247, 81283, 81306, 81328, 81335, 81350, 81355, 81374, 81377, 81381, 81383, 81401, 81406, 81418, 81479, 0029U, 0030U, 0034U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0286U, 0345U, 0380U, 0411U, 0419U | A58324 – Billing and Coding: MolDX: Pharmacogenomics Testing |
L38584 | MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells | 7/25/21 | 5/16/24 | 5/9/24 | Active | 81479 | A58063 – Billing and Coding: MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells |
L38111 | MolDX: Pigmented Lesion Assay | 3/30/20 | 10/26/23 | 10/19/23 | Active | 0089U | A57915 – Billing and Coding: MolDX: Pigmented Lesion Assay |
L38065 | MolDX: Plasma-Based Genomic Profiling in Solid Tumors | 7/27/20 | 10/26/23 | 10/19/23 | Active | Group 1: 81445, 81479, 0326U, 0409U, 0428U, 0485U Group 2: 0179U, 0487U |
A57917 – Billing and Coding: MolDX: Plasma-Based Genomic Profiling in Solid Tumors |
L38284 | MolDX: Predictive Classifiers for Early Stage Non-small Cell Lung Cancer | 7/27/20 | 10/20/22 | 10/10/22 | Active | 81479, 0288U | A58038 – Billing and Coding: MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer |
L38586 | MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer | 7/18/21 | 3/21/24 | 3/14/24 | Active | 81401, 81403, 81404, 81445, 81479, 0016M | A58065 – Billing and Coding: MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer |
L37352 | MolDX: Prometheus IBD sgi Diagnostic® Policy | 11/6/17 | 2/29/24 | 2/21/24 | Active | 81479 | A56940 – Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy |
L38303 | MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease | 11/9/20 | 7/25/24 | 7/17/24 | Active | 81541, 81542, 0047U | A58371 – Billing and Coding: MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease |
L38288 | MolDX: Repeat Germline Testing | 6/7/20 | 4/25/24 | 4/18/24 | Active | See the Coding Information section in the article. | A57141 – Billing and Coding: MolDX: Repeat Germline Testing |
N/A | MolDX: Testing of Multiple Genes | 1/1/20 | 11/22/23 | 11/15/23 | Active | N/A | A57910 – Billing and Coding: MolDX: Testing of Multiple Genes |
L34171 | Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation | 10/1/15 | 6/6/24 | 5/31/24 | Active | 68801, 68810, 68811, 68815, 68816, 68840 | A57284 – Billing and Coding: Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation |
L35249 | Nerve Blocks for Peripheral Neuropathy | 10/1/15 | 5/9/24 | 4/30/24 | Active | Group 1: 64450 Group 2: 76881, 76882, 76942, 76999, 97032, 97139, G0282, G0283 |
A57663 – Billing and Coding: Nerve Blocks for Peripheral Neuropathy |
L35897 | Nerve Conduction Studies and Electromyography | 10/1/15 | 5/9/24 | 4/30/24 | Active | 51784, 51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937, 95999, G0255 | A57307 – Billing and Coding: Nerve Conduction Studies and Electromyography |
L38771 | Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease | 04/25/21 | 9/5/24 | 8/26/24 | Active | 75580 | A58359 – Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease |
L34045 | Non-Invasive Vascular Studies | 10/1/15 | 11/2/23 | 10/27/23 | Active | Group 1: 93880, 93882, Group 2: 93886, 93888, 93890, 93892, 93893 Group 3: 93922, 93923, 93924, 93925, 93926, 93930, 93931 Group 4: 93970, 93971 Group 5: 93975, 93976, 93978, 93979 Group 6: 93985, 93986, 93990 Group 7: 93930, 93931, 93970, 93971 Group 8: 93970, 93971 |
A56697 – Billing and Coding: Non-Invasive Vascular Studies |
L34393 | Ocular Photography – External | 10/1/15 | 5/9/24 | 4/30/24 | Active | 92285 | A57068 – Billing and Coding: Ocular Photography – External |
N/A | Off-Label Use of Chemotherapeutic Drugs and Biologicals for Non-Cancer Indications | 1/1/22 | 11/16/23 | 11/7/23 | Active | N/A | A59006 – Off-Label Use of Chemotherapeutic Drugs and Biologicals for Non-Cancer Indications |
N/A | Off-Label Use of Drugs and Biologicals for Anti-Cancer Chemotherapeutic Regimen | 6/8/20 | 11/16/23 | 11/7/23 | Active | N/A | A58113 – Off-Label Use of Drugs and Biologicals for Anti-Cancer Chemotherapeutic Regimen |
L38920 | Off-label Use of Rituximab and Rituximab Biosimilars | 8/8/21 | 6/29/23 | 6/22/23 | Active | J9312, Q5115, Q5119 | A58582 – Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars |
L34175 | Ophthalmic Angiography (Fluorescein and Indocyanine Green) | 10/1/15 | 6/6/24 | 5/31/24 | Active | 92235, 92240 | A57069 – Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green) |
L34181 | Ophthalmic Biometry for Intraocular Lens Power Calculation | 10/1/15 | 6/6/24 | 5/31/24 | Active | 76519, 92136 | A57070 – Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation |
L34399 | Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) | 10/1/15 | 6/6/24 | 5/31/24 | Active | 92201, 92202, 92227, 92228, 92250 | A57071 – Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) |
N/A | Osteopathic Manipulative Treatment | 10/1/15 | 11/22/23 | 11/15/23 | Active | 98925, 98926, 98927, 98928, 98929 | A52435 – Billing and Coding: Osteopathic Manipulative Treatment |
L34049 | Outpatient Physical and Occupational Therapy Services | 10/1/15 | 6/6/24 | 5/31/24 | Active | Group 1: 29065, 29075, 29085, 29086, 29105, 29125, 29126, 29130, 29131, 29200, 29240, 29260, 29280, 29345, 29355, 29365, 29405, 29425, 29445, 29505, 29515, 29520, 29530, 29540, 29550, 29580, 29799, 90901, 90912, 90913, 95851, 95852, 96125, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97535, 97537, 97542, 97597, 97598, 97602, 97605, 97606, 97607, 97608, 97750, 97755, 97760, 97761, 97763, 97799, G0281, G0283, G0329 Group 2 98966, 98967, 98968, 98970, 98971, 98972, 98975, 98976, 98977, 98980, 98981, G2010, G2012, G2250, G2251 |
A57067 – Billing and Coding: Outpatient Physical and Occupational Therapy Services |
L34353 | Outpatient Psychiatry and Psychology Services | 10/1/15 | 6/6/24 | 5/31/24 | Active | 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90865, 90870, 90880, 90885, 90887, 90889, 90899, 96105, 96110, 96112, 96113, 96116, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146 | A57065 – Billing and Coding: Outpatient Psychiatry and Psychology Services |
L34064 | Panretinal (Scatter) Laser Photocoagulation | 10/1/15 | 4/4/24 | 3/29/24 | Active | 67228 | A56594 – Billing and Coding: Panretinal (Scatter) Laser Photocoagulation |
N/A | Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506 | 5/26/22 | 3/14/24 | 3/5/24 | Active | 96372, 96377, J2506, Q5111 | A59126 – Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506 |
L38201 | Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) | 11/18/19 | 10/3/24 | 9/27/24 | Active | 22510, 22511, 22512, 22513, 22514, 22515 | A57282 – Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) |
L39023 | Platelet Rich Plasma Injections for Non-Wound Injections | 1/3/22 | 7/21/22 | 2/9/23 | Active | G0460, M0076, P9020, 0232T | A58737 – Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections |
L36902 | Polysomnography and Other Sleep Studies | 3/6/17 | 3/7/24 | 2/29/24 | Active | Group 1: 95782, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400 Group 2: 95803 |
A57049 – Billing and Coding: Polysomnography and Other Sleep Studies |
L39521 | Positron Emission Tomography (PET) Scan for Inflammation and Infection | 8/13/23 | N/A | 6/22/23 | Active | Group 1: 78811, 78812, 78813, 78814, 78815, 78816, A9552, A9598, A9601 Group 2: 78429, 78432, 78433, 78459 Group 3: 78811, 78812, 78813, 78814, 78815, 78816 Group 4: 78608, 78609, G0219, G0235, G0252 |
A59318 – Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection |
L34085 | Post-Void Residual Urine and/or Bladder Capacity by Ultrasound | 10/1/15 | 4/4/24 | 3/29/24 | Active | 51798 | A57050 – Billing and Coding: Post-Void Residual Urine and / or Bladder Capacity by Ultrasound |
N/A | Process for Determining Self-Administered Drug Exclusions – Medical Policy Article | 10/1/15 | 8/8/24 | 7/29/24 | Active | N/A | A52535 – Process for Determining Self-Administered Drug Exclusions – Medical Policy Article |
L36675 | ProMark® Risk Score | 10/10/16 | 12/7/23 | 11/29/23 | Active | 81479 | A57034 – Billing and Coding: ProMark® Risk Score |
L39284 | Prostate Cancer Detection with IsoPSA® | 11/20/22 | 11/2/23 | 10/27/23 | Active | 0359U | A59066 – Billing and Coding: Prostate Cancer Detection with IsoPSA® |
L36658 | Proton Beam Therapy | 10/24/16 | 10/3/24 | 9/27/24 | Active | 77520, 77522, 77523, 77525 | A55315 – Billing and Coding: Proton Beam Therapy |
L34183 | Psychiatric Inpatient Hospitalization | 10/1/15 | 4/4/24 | 3/29/24 | Active | N/A | A57052 – Billing and Coding: Psychiatric Inpatient Hospitalization |
L34196 | Psychiatric Partial Hospitalization Programs | 10/1/15 | 4/4/24 | 3/29/24 | Active | 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90849, 90853, 90899, 96116, 96130, 96131, 96136, 96137, 96138, 96139, 96146, G0129, G0176, G0177, G0410, G0411 | A57053 – Billing and Coding: Psychiatric Partial Hospitalization Programs |
L34539 | Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians | 10/1/15 | 4/4/24 | 3/29/24 | Active | 90785, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90846, 90847, 90849, 90853, 90863, 90880, 90899 | A57054 – Billing and Coding: Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians |
L34063 | RAST Type Tests | 10/1/15 | 8/8/24 | 7/29/24 | Active | 86001, 86003, 86005 | A57043 – Billing and Coding: RAST Type Tests |
L34200 | Removal of Benign Skin Lesions | 10/1/15 | 8/8/24 | 7/29/24 | Active | 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17000, 17003, 17004, 17106, 17107, 17108, 17110, 17111, 17340 | A57044 – Billing and Coding: Removal of Benign Skin Lesions |
N/A | Rezum® System for Benign Prostatic | 1/1/18 | 8/8/24 | 7/29/24 | Active | 53854 | A56083 – Billing and Coding: Rezum® System for Benign Prostatic |
L34246 | Routine Foot Care and Debridement of Nails | 10/1/15 | 8/8/24 | 7/29/24 | Active | 11055, 11056, 11057, 11719, 11720, 11721, G0127 | A57193 – Billing and Coding: Routine Foot Care and Debridement of Nails |
N/A | Sacral Nerve Stimulation for Urinary and Fecal Incontinence | 2/1/18 | 3/7/24 | 2/29/24 | Active | Group 1: 64561, 64581 Group 2: 64590, A4290, C1767, C1778, C1883, C1897, L8680 |
A55835 – Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence |
L39383 | Sacroiliac Joint Injections and Procedures | 3/19/23 | 4/4/24 | 3/29/24 | Active | Group 1: 27096, 64451 Group 2: 64625 Group 3: G0260 |
A59154 – Billing and Coding: Sacroiliac Joint Injections and Procedures |
L34061 | Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) | 10/1/15 | 8/8/24 | 7/29/24 | Active | 92133, 92134 | A56692 – Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) |
N/A | Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage – Medical Policy Article | 10/1/15 | 6/30/24 | 5/9/24 | Active | See the Coding Information section in the article. | A52527 – Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage – Medical Policy Article |
N/A | Sentinel Lymph Node Biopsy – Medical Policy Article | 10/1/15 | 11/16/23 | 11/7/23 | Active | 38500, 38510, 38525, 38530, 38542, 38790, 38792, 38900, 78195, A4641, A4649, A9541 | A52437 – Billing and Coding: Sentinel Lymph Node Biopsy – Medical Policy Article |
N/A | Single Chamber and Dual Chamber Permanent Cardiac Pacemakers – Coding and Billing | 5/1/16 | 11/16/23 | 11/7/23 | Active | 33206, 33207, 33208 | A54961 – Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers |
L35906 | Somatosensory Testing | 10/1/15 | 4/4/24 | 3/29/24 | Active | 95925, 95926, 95927, 95928 | A57041 – Billing and Coding: Somatosensory Testing |
L35986 | Special Histochemical Stains and Immunohistochemical Stains | 10/1/15 | 3/7/24 | 2/29/24 | Active | 88341, 88342, 88360, 88361 | A59292 – Billing and Coding: Lab: Immunohistochemistry (IHC) Indications for Breast Pathology |
L34046 | Speech-Language Pathology | 10/1/15 | 8/8/24 | 7/29/24 | Active | 31579, 92507, 92508, 92521, 92522, 92523, 92524, 92597, 92607, 92608, 92609, 92626, 92627, 96105, 96110, 96112, 96113, 96125, 97129, 97130, 97533 | A57040 – Billing and Coding: Speech-Language Pathology |
L34540 | Stretta Procedure | 10/1/15 | 9/5/24 | 8/26/24 | Active | 43257 | A57039 – Billing and Coding: Stretta Procedure |
L34087 | Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based | 10/1/15 | 9/5/24 | 8/26/24 | Active | 93282, 93283, 93284, 93287, 93289, 93292, 93295, 93296 | A57038 – Billing and Coding: Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based |
N/A | Tetanus Immunization | 10/1/15 | 1/4/24 | 12/29/23 | Active | 90702, 90714, J1670 | A52438 – Billing and Coding: Tetanus Immunization |
N/A | Therapeutic Apheresis for Familial Hypercholesterolemia | 12/1/18 | 2/1/24 | 1/25/24 | Active | 36516 | A56289 – Billing and Coding: Therapeutic Apheresis for Familial Hypercholesterolemia |
L34084 | Transcatheter Infusion Therapy | 10/1/15 | 9/5/24 | 8/26/24 | Active | 61650, 61651 | A56811 – Billing and Coding: Transcatheter Infusion Therapy |
L36469 | Transcranial Magnetic Stimulation (TMS) | 2/8/16 | 6/6/24 | 5/30/24 | Active | 90867, 90868, 90869 | A57047 – Billing and Coding: Transcranial Magnetic Stimulation (TMS) |
L34337 | Transesophageal Echocardiography (TEE) | 10/1/15 | 9/5/24 | 8/26/24 | Active | 76376, 76377, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93320, 93321, 93325, C8925, C8926, C8927 | A56809 – Billing and Coding: Transesophageal Echocardiography (TEE) |
L34541 | Transtelephonic Spirometry | 10/1/15 | 10/3/24 | 9/27/24 | Active | 94014, 94015, 94016 | A56808 – Billing and Coding: Transtelephonic Spirometry |
L34338 | Transthoracic Echocardiography (TTE) | 10/1/15 | 10/3/24 | 9/27/24 | Active | Group 1: 76376, 76377, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350, 93351, 93352, A9700, C8921, C8922, C8923, C8924, C8928, C8929, C8930, Q9955, Q9956, Q9957 Group 2: C9399, J0153, J0280, J0461, J1245, J1250, J2785, J3490 |
A57306 – Billing and Coding: Transthoracic Echocardiography (TTE) |
N/A | Traumeel Injections | 10/1/15 | 1/4/24 | 12/29/23 | Active | N/A | A52537 – Traumeel Injections |
L39656 | Trigger Point Injections (TPI) | 4/1/24 | 4/1/24 | 3/5/24 | Active | 20552, 20553 | A59480 – Billing and Coding: Trigger Point Injections (TPI) |
L39616 | Urinary Biomarkers for Chronic Pain Management | 10/8/23 | N/A | N/A | Active | 0117U | A59423 – Billing and Coding: Urinary Biomarkers for Chronic Pain Management |
L36029 | Urine Drug Testing | 10/5/15 | 3/7/24 | 2/28/24 | Active | 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659 | A56818 – Billing and Coding: Urine Drug Testing |
L34056 | Urodynamics | 10/1/15 | 10/3/24 | 9/27/24 | Active | 51725, 51726, 51727, 51728, 51729, 51736, 51741, 51792, 51797 | A56802 – Billing and Coding: Urodynamics |
L34082 | Varicose Veins of the Lower Extremity, Treatment of | 10/1/15 | 10/3/24 | 9/27/24 | Active | 36465, 36466, 36468, 36470, 36471, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37799, 76942, 93970, 93971 | A57305 – Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of |
N/A | Venipuncture Necessitating Physician's Skill for Specimen Collection – Supplemental Instructions Article | 10/1/15 | 8/8/24 | 7/29/24 | Active | 36410, 36415 | A52470 – Billing and Coding: Venipuncture Necessitating Physician's Skill for Specimen Collection – Supplemental Instructions Article |
L34055 | Virtual Colonoscopy (CT Colonography) | 10/1/15 | 10/3/24 | 9/27/24 | Active | Group 1: 74261, 74262 Group 2: 74263 |
A56800 – Billing and Coding: Virtual Colonoscopy (CT Colonography) |
L34394 | Visual Fields Testing | 10/1/15 | 10/3/24 | 9/27/24 | Active | 92081, 92082, 92083 | A56799 – Billing and Coding: Billing and Coding for Visual Fields Testing |
L33996 | Vitamin D Assay Testing | 10/1/15 | 8/8/24 | 7/29/24 | Active | 82306 | A56798 – Billing and Coding: Vitamin D Assay Testing |
L36690 | Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities | 10/10/16 | 9/5/24 | 8/26/24 | Active | Group 1: 15002, 15003, 15004, 15005, 15040, 15050, 15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, A2001, C5271, C5272, C5273, C5274, C5275, C5276, C5277, C5278 Group 2: A2001, A2002, A2004, A2008, Q4100, Q4101, Q4102, Q4103, Q4104, Q4105, Q4106, Q4107, Q4108, Q4110, Q4111, Q4115, Q4117, Q4118, Q4121, Q4122, Q4123, Q4124, Q4126, Q4127, Q4128, Q4132, Q4133, Q4134, Q4135, Q4136, Q4137, Q4140, Q4141, Q4146, Q4147, Q4148, Q4151, Q4152, Q4153, Q4154, Q4156, Q4157, Q4158, Q4159, Q4160, Q4161, Q4163, Q4164, Q4165, Q4166, Q4169, Q4170, Q4173, Q4175, Q4176, Q4178, Q4180, Q4186, Q4187, Q4188, Q4195, Q4196, Q4197, Q4201, Q4203, Q4232, Q4236, Q4237, Q4238, Q4239, Q4253, Q4254, Q4262, Q4278 |
A56696 – Billing and Coding: Wound Application of Cellular and / or Tissue Based Products (CTPs), Lower Extremities |
Updated: 11.01.24