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Medical Policies

Coverage for services under Medicare is primarily established through the Social Security Act. Provisions of the Social Security Act are applied to specific services based on various regulations, National Coverage Determinations established by the Centers for Medicare & Medicaid Services (CMS), various CMS guidelines, and Local Coverage Determinations (LCDs) established by CGS.

NCDs are developed by CMS to describe the circumstances for Medicare coverage nationwide for an item or service.
LCDs are developed by Medicare Administrative Contractors (MACs), including CGS, and indicate whether a particular item or service is covered in accordance with the Social Security Act, section 1862(a)(1)(A). (See list of LCDs below.)
NCDs and LCDs only address certain services and items; in other words, not every item or service has a corresponding NCD or LCD. In these cases, the Social Security Act, and in some cases, additional guidance published by CMS, establish the basis for coverage.
For more information about NCDs, LCDs, and other coverage provisions, refer to the CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 13.
CAC Compliance Open and Provider Touch Point Meetings
- CAC and Open LCD Discussion Recordings

IMPORTANT NOTE: CGS does NOT house LCDs on our website. By following the links below you will be sent directly to the CMS Medicare Coverage Database (MCD). When using the individual links provided below there may be times that you will receive the message "superseded", indicating you are not viewing the most current LCD. This is due to system processes which cause a delay in updating these links. If you get the note "superseded" on a policy, please use the main link listed below for current LCDs to the MCD provided while we complete the process of updating the individual links.

The following CGS Part A Local Coverage Determinations (LCDs) are located on the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database (MCD) webpage. CMS also provides the LCD Contractor Index, where providers can browse LCDs by contractor.

ID	Title / ID	Effective Date	Revision Effective Date	Last Updated	Status	HCPC/CPT code	Related Policy Article(s)
L32553	Allergy Immunotherapy	10/1/15	11/7/19	10/29/19	Active	95115, 95117, 95144, 95145, 95146, 95147, 95148, 95149, 95165, 95170, 95180, 95199	A56424 – Billing and Coding: Allergy Immunotherapy
L33943	B-type Natriuretic Peptide (BNP) Testing	10/1/15	11/28/19	11/25/19	Active	83880	A56425 – Billing and Coding: B-type Natriuretic Peptide (BNP) Testing
L36975	Bladder/Urothelial Tumor Markers	3/6/17	10/31/19	1/24/20	Active	86294, 86316, 86386, 88120, 88121	A56471 – Billing and Coding: Bladder / Urothelial Tumor Markers
L33944	Blepharoplasty	10/1/15	11/7/19	10/30/19	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	12/26/19	12/20/19	Active	76977, 77078, 77080, 77081, 77085, 78350, 78351, G0130, 0508T, 0554T, 0555T, 0556T, 0557T, 0558T	A57132 – Billing and Coding: Bone Mass Measurement
L33949	Botulinum Toxins	10/1/15	11/28/19	11/25/19	Active	Group 1: 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	11/28/19	11/25/19	Active	77065, 77066, 77067	A56448 – Billing and Coding: Breast Imaging Mammography / Breast Echography (Sonography) / Breast MRI / Ductography
L33946	Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy	10/1/15	11/7/19	10/30/19	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	11/7/19	10/30/19	Active	Group 1: 92978, 92979, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93464, 93503, 93505 ,93530 ,93531 ,93532 ,93533, 93561, 93562, 93563, 93564, 93565, 93566 ,93567, 93568 , 93571 , 93572 , 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	9/19/19	10/30/19	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	9/19/19	11/25/19	Active	93228, 93229, 93268,93270, 93271 ,93272, 93799	A56452 – Billing and Coding: Cardiac Event Detection
L33960	Cardiovascular Nuclear Medicine	10/1/15	9/19/19	1/24/20	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	12/16/16	12/20/19	Active	66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984	A56453 – Billing and Coding: Cataract Extraction
L34370	Category III CPT® Codes	10/1/15	12/26/19	12/20/19	Active	Group 1: NA Group 2: 0295T, 0296T, 0297T, 0298T Group 3: 0308T	A54327 – Billing and Coding: ArgusM II Retinal Prosthesis System A57230 – Billing and Coding: Category III CPT® Codes
L33945	Cerumen (Earwax) Removal	10/1/15	9/19/19	1/24/20	Active	69209, 69210, G0268	A56454 – Billing and Coding: Cerumen (Earwax) Removal
L34093	Chemotherapy and Biologicals	10/1/15	10/3/19	9/25/19	Active		Click to expand the full list of related policy articles A56701 – Billing and Coding: Ado-Trastuzumab Emtansine – J9354 A56831 – Billing and Coding: Aldesleukin; Proleukin, Interleukin II (IL-2) – J9015 A56832 – Billing and Coding: Alemtuzumzb (Campath) – J0202 A56698 – Billing and Coding: Arsenic Trioxide (Trisenox) – J9017 A56699 – Billing and Coding: Asparaginase (E.coli)(Elspar) – J9019 A56700 – Billing and Coding: Asparaginase Erwinia Chrysanthemi (Erwinaze) – J9020 A56830 – Billing and Coding: Atezolizumab (Tecentriq) – J9022 A52422 – Billing and Coding: Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer (Sipuleucel-T;Provenge)-Q2043 A56833 – Billing and Coding: Avelumab ( Bavencio) – J9023 A56834 – Billing and Coding: Azacitidine (Vidaza) – J9025 A56627 – Billing and Coding: Beleodaq (Belinostat)-J9032 A56889 – Billing and Coding: Bendamustine hydrochloride; Bendeka – J9034 A56888 – Billing and Coding: Bendamustine hydrochloride; Treanda A56604 – Billing and Coding: Bevacizumab: Avastin-J9035 A56890 – Billing and Coding: Bleomycin Sulfate (Blenoxane) – J9040 A56886 – Billing and Coding: Blinatumomab (Blincyto) – J9039 A56891 – Billing and Coding: Bortezomib (Velcade) – J9041 A56892 – Billing and Coding: Brentuximab Vedotin (Adectris) – J9042 A56893 – Billing and Coding: Cabazitaxel; Jevtana – J9043 A52530 – Billing and Coding: Capsaicin 8% patch (Qutenza®)-J7336 A56939 – Billing and Coding: Carboplatin – J9045 A56894 – Billing and Coding: Carfilzomib (Kyprolis) – J9047 A57234 – Billing and Coding: Cetuximab; Erbitux – J9055 A57239 – Billing and Coding: Danorubicin Citrate Liposomal-J9151 A57240 – Billing and Coding: Danorubicin Hcl-J9150 A57243 – Billing and Coding: Daratumumab (Darzalex)-J9145 A57244 – Billing and Coding: Decitabine; DACOGEN – J0894 A57245 – Billing and Coding: Denileukin Diftitox; Ontak – J9160 A56534 – Billing and Coding: Denosumab (Prolia™, Xgeva™)-J0897 A56577 – Billing and Coding: Docetaxel; Taxotere – J9171 A57270 – Billing and Coding: Doxorubicin, Doxorubician Hydrochoride – J9000 A57280 – Billing and Coding: Doxorubicin, Liposomal; Doxil, Caelyx Doxorubicin hydrochloride, all lipid formulations – Q2049,Q2050 A56543 – Billing and Coding: Durvalumab (Imfinzi)-J9173 A56895 – Billing and Coding: Eculizumab; Soliris – J1300 A57246 – Billing and Coding: Elotuzumab (Empliciti) – J9176 A57289 – Billing and Coding: Epirubicin; Epirubicin HC1 – J9178 A57247 – Billing and Coding: Eribulin Mesylate; Halaven – J9179,J3490, J3590 A57319 – Billing and Coding: Etoposide – J9181 A57248 – Billing and Coding: Floxuridine – J9200 A56628 – Billing and Coding: Fluocinolone Acetonide Intravitreal Implant – J7311 A57339 – Billing and Coding: Gemcitabine Gemzar, Gemcitabine hydrochloride – J9201 A57249 – Billing and Coding: Gemtuzumab Ozogamicin; Mylotarg – J9203 A57250 – Billing and Coding: Goserelin Acetate Implant-J9202 A57341 – Billing and Coding: Ifosfamide – J9208 A56578 – Billing and Coding: Infliximab-J1745, Q5103, Q5104 A57251 – Billing and Coding: Ipilimumab (Yervoy)-J9228 A57255 – Billing and Coding: Irinotecan Lipsome Injection (Onivyde)-J9999 A57252 – Billing and Coding: Irinotecan-J9205 A57254 – Billing and Coding: Irinotecan-J9206 A56629 – Billing and Coding: Iron Sucrose, Iron Dextran and Ferumoxytol, (Intravenous Iron Therapy)-J1439, J1750, J1756, Q0138, Q0139 A57257 – Billing and Coding: Ixabepilone; Ixempra Injection – J9207 A57259 – Billing and Coding: Leuprolide Acetate ( for depot suspension)-J9217 A57258 – Billing and Coding: Leuprolide Acetate (for depot suspension)-J1950 A57260 – Billing and Coding: Leuprolide acetate implant; Lupron implant-J9219 A57261 – Billing and Coding: Marqibo (VinCRIStine Sulfate Liposome) – J9371 A57278 – Billing and Coding: Mitomycin – J9280 A57262 – Billing and Coding: Necitumumab (Portrazza) – J9295 A56829 – Billing and Coding: Neulasta® (pegfilgrastim) – J2505,Q5108,Q5111 A57315 – Billing and Coding: Nivolumab (Opdivo) – J9299 A57316 – Billing and Coding: Obinutuzumab (Gazyva) – J9301 A57317 – Billing and Coding: Ofatumumab; Arzerra – J9302 A57318 – Billing and Coding: Oxaliplatin; Eloxatin – J9263 A57345 – Billing and Coding: Paclitaxel protein-bound particles; Abraxane – J9264 A56579 – Billing and Coding: Paclitaxel; Taxol – J9267 A56806 – Billing and Coding: Pamidronate Disodium; Aredia – J2430 A56810 – Billing and Coding: Panitumumab; Vectibix – J9303 A57346 – Billing and Coding: Pembrolizumab (Keytruda) – J9271 A57263 – Billing and Coding: Pemetrexed; Alimta – J9305 A57264 – Billing and Coding: Pertuzumab – J9306 A57324 – Billing and Coding: Porfimer Sodium; Photofrin – J9600 A57328 – Billing and Coding: Pralatrexate; Folotyn; Injection – J9307 A57325 – Billing and Coding: Ramucirumab (Cyramza) – J9308 A57321 – Billing and Coding: Rituximab – J9311, J9312, J9999, Q5115 A56630 – Billing and Coding: Sodium Ferric Gluconate, (Intravenous Iron Therapy) – J2916 opens in new window A57302 – Billing and Coding: Talimogene laherparepvec – J9325 A57300 – Billing and Coding: Thyrotropin Alfa (Thyrogen®) – J3240 A57301 – Billing and Coding: Tisagenlecleucel (Kymriah) – Q2042 A57359 – Billing and Coding: Topotecan; Hycamtin – J9351 A57298 – Billing and Coding: Trabectedin – J9352 A57299 – Billing and Coding: Trastuzumab; Herceptin – J9355 A57297 – Billing and Coding: Triptorelin Pamoate – J3315 A57295 – Billing and Coding: Vantas Implant, Histrelin implant – J9225 A57294 – Billing and Coding: Vantas Implant; Supprelin LA – J9226 A56835 – Billing and Coding: Vedolizumab (Entyvio) – J3380 A57360 – Billing and Coding: Vinorelbine Tartrate – J9390 A57293 – Billing and Coding: Xofigo – A9699 A57358 – Billing and Coding: Yttrium y-90 Ibritumomab tiuxetan – A9543 A57362 – Billing and Coding: Zoledronic Acid – J3489
L37254	Chiropractic Services	11/6/17	9/19/19	9/19/19	Active	98940, 98941, 98942	A56456 – Billing and Coding: Colonoscopy / Sigmoidoscopy / Proctosigmoidoscopy
L37126	Coenzyme Q10 (CoQ10)	7/10/17	9/19/19	12/27/19	Active	82542	A55715 – Billing and Coding: Coenzyme Q10 (CoQ10)
L34005	Colonoscopy/Sigmoidoscopy/ Proctosigmoidoscopy	10/1/15	9/19/19	1/24/20	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
L34008	Computerized Corneal Topography	10/1/15	9/19/19	1/28/20	Active	92025	A56816 – Billing and Coding: Computerized Corneal Topography
L36029	Controlled Substance Monitoring and Drugs of Abuse Testing	10/5/15	11/21/19	11/15/19	Active	80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659, 0143U, 0144U, 0145U, 0146U, 0147U, 0148U, 0149U, 0150U	A56818 – Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
L33999	Corneal Pachymetry	10/1/15	9/19/19	1/28/20	Active	76514	A56457 – Billing and Coding: Billing and Coding for Corneal Pachymetry
L34032	Debridement Services	10/1/15	9/12/19	1/28/20	Active	11000, 11001, 11042, 11043, 11044, 11045, 11046, 11047	A56459 – Billing and Coding: Debridement Services
L34062	Dialysis Access Maintenance	10/1/15	9/19/19	1/28/20	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
L34081	Endoscopy by Capsule	10/1/15	9/19/19	2/28/20	Active	Group 1: 91110 Group 2: 91111, 91299	A56461 – Billing and Coding: Endoscopy by Capsule
L34356	Erythropoiesis Stimulating Agents (ESA)	10/1/15	10/3/19	2/24/20	Active	J0881, J0882, J0885, J0890. Q4081, Q5105, Q5106	A56462 – Billing and Coding: Erythropoiesis Stimulating Agents (ESA)
L34832	Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy	10/1/15	12/26/19	12/20/19	Active	64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636	A56463 – Billing and Coding: Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
L34037	Flow Cytometry	10/1/15	10/1/19	2/24/20	Active	Group 1: 88182, 88184, 88185, 88187, 88188, 88189 Group 2: 86355, 86356, 86357, 86359, 86360, 86361, 86367	A56464 – Billing and Coding: Flow Cytometry
L37575	Frequency of Hemodialysis	4/1/19	10/1/19	1/28/20	Active	90999	A56159 – Billing and Coding: Frequency of Hemodialysis
L36906	GlycoMark Testing for Glycemic Control	3/6/17	10/31/19	3/25/20	Active	84378, 84999	A56465 – Billing and Coding: GlycoMark Testing for Glycemic Control
L34089	Human Papillomavirus (HPV) Testing	10/1/15	9/19/19	3/25/20	Active	87623, 87624	A56466 – Billing and Coding: Human Papillomavirus (HPV) Testing
L35891	Intravenous Immune Globulin	10/1/15	9/19/19	3/25/20	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	9/19/19	3/25/20	Active	52647, 52648, 52649	A56467 – Billing and Coding: Laser Ablation of the Prostate
L34807	Lumbar Epidural Steroid Injections (ESI)	10/1/15	12/26/19	12/20/19	Active	62323, 62327, 64483, 64484	A56469 – Billing and Coding: Lumbar Epidural Steroid Injections (ESI)
L37790	Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor	10/1/18	9/19/19	9/23/19	Active	0398T	A56470 – Billing and Coding: Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor
L37578	Micro-Invasive Glaucoma Surgery (MIGS)	3/19/18	12/30/18	3/25/20	Active	Group 1: 0191T Group 2: 0449T Group 3: 0253T, 0376T, 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	12/26/19	12/20/19	Active	27279	A56535 – Billing and Coding: Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
L34195	Mohs Micrographic Surgery	10/1/15	8/8/19	9/13/19	Active	17311, 17312, 17313, 17314, 17315	A56836 – Billing and Coding: Mohs Micrographic Surgery
L36979	MolDX: 4Kscore Assay	3/13/17	10/31/19	11/25/19	Active	81539	A56944 – Billing and Coding: MolDX: 4Kscore Assay
L37362	MolDX: AlloSure® Donor-Derived Cell-Free DNA Test	3/6/18	10/31/19	1/23/20	Active	81479	A57032 – Billing and Coding: MolDX: AlloSure® Donor-Derived Cell-Free DNA Test
L36910	MolDX: APC and MUTYH Gene Testing	3/13/17	11/28/19	11/21/19	Active	Group 1: 81201, 81202, 81203 , 81479 Group 2: 81401, 81403, 81406, 81435, 81436 Group 3: 0157U	A56828 – Billing and Coding: MolDX: APC and MUTYH Gene
L37134	MolDX: BDX-XL2	7/10/17	10/24/19	10/17/19	Active	0080U	A56947 – Billing and Coding: MolDX: BDX-XL2
L36139	MolDX: Biomarkers in Cardiovascular Risk Assessment	10/5/15	11/14/19	11/5/19	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 Coding and Billing Guidelines A57386 – Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
L36456	MolDX: BRCA1 and BRCA2 Genetic Testing	2/15/16	1/9/20	12/31/19	Active	Group 1: 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433, 81479, 0102U, 0103U, 0129U Group 2: 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U Group 3: 81162, 81445, 81455	A56971 – Billing and Coding: MolDX: BRCA1 and BRCA2 Genetic Testing A54689 – Billing and Coding: MolDX: Myriad’s BRACAnalysis CDx™
L36425	MolDX: Breast Cancer Assay: Prosigna	2/1/16	9/23/19	11/15/19	Active	81520	A56989 – Billing and Coding: MolDX: Breast Cancer Assay: Prosigna
L37832	MolDX: Breast Cancer™ (BCI) Gene Expression Test	4/1/19	10/31/19	4/30/20	Active	81518	A56884 – Billing and Coding: MolDX: Breast Cancer Index™ (BCI) Gene Expression Test
L36006	MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay	10/5/15	11/7/19	10/28/19	Active	81551	A57031 – Billing and Coding: MolDX: ConfirmMDx Epigenetic Molecular Assay
L36675	MolDX - CDD: ProMark Risk Score	10/10/16	11/28/19	11/21/19	Active	81479	A57034 – Billing and Coding: MolDX- CDD: ProMark Risk Score
L36973	MolDX: Circulating Tumor Cell Marker Assays	3/6/17	11/7/19	3/25/20	Active	86152, 86153	A57288 – Billing and Coding: MolDX: Circulating Tumor Cell Marker Assays
L37787	MolDX: Corus® CAD Assay	11/12/18	9/19/19	11/25/19	Active	81493	A56950 – Billing and Coding: MolDX: Corus® CAD Assay
L35332	MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing	10/1/15	9/23/19	10/17/19	Active	Group 1: 81225 Group 2: 81226, 0070U Group 3: 81227, 81355 Group 4: 81479	A56864 – Billing and Coding: MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
L37598	MolDX: Cystatin C Measurement	12/17/18	11/28/19	12/27/19	Active	82610	A56988 – Billing and Coding: MolDX: Cystatin C Measurement
L37834	MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease	4/29/19	1/9/20	3/25/20	Active	81542	A56984 – Billing and Coding: MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease
L36656	MolDX: Decipher® Prostate Cancer Classifier Assay	10/10/16	11/14/19	11/25/19	Active	81542	A56992 – Billing and Coding: MolDX: Decipher® Prostate Cancer Classifier Assay
L38016	MolDX: DecisionDx-Melanoma	6/24/19	10/3/19	9/26/19	Active	81599	A56990 – Billing and Coding: MolDX: DecisionDx-Melanoma
L37130	MolDX: DecisionDx-UM (Uveal Melanoma)	7/10/17	10/31/19	12/27/19	Active	81552	A56981 – Billing and Coding: MolDX: DecisionDx-UM (Uveal Melanoma)
L37356	MolDX: EndoPredict Breast Cancer Gene Expression Test	3/6/18	11/14/19	11/8/19	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	11/7/19	2/28/20	Active	81479	A56985 – Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
L37364	MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)	1/7/19	11/28/19	11/21/19	Active	Group 1: 87505, 87506, 0097U Group 2: 87507	A56596 – Billing and Coding: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs)
L35443	MolDX: GeneSight Assay for Refractory Depression	10/1/15	11/28/19	11/21/19	Active	81479	A56936 – Billing and Coding: MolDX: GeneSight® Assay for Refractory Depression
L36117	MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease	10/5/15	12/19/19	12/13/19	Active	Group 1: 81206, 81207, 81208, 81219, 81270, 81402, 81479, 0040U Group 2: 81403, 81445, 81450, 81455	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	10/31/15	10/23/19	Active	81240, 81241, 81291	A56980 – Billing and Coding: MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L35349	MolDX: Genetic Testing for Lynch Syndrome	10/1/15	12/5/19	12/31/19	Active	Group 1: 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81317, 81318, 81319, 81479, 88341,88342, 0101U Group 2: 81445, 81455, 0130U, 0134U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U Group 3: 81301, 81403, 81435, 81436	A56882 – Billing and Coding: MolDX: Genetic Testing for Lynch Syndrome A56106 – Billing and Coding: MolDX: Microsatellite Instability-High (MSI-H) and Mismatch Repair Deficient (dMMR) Biomarker for Patients with Unresectable or Metastatic Solid Tumors
L36206	MolDX: Genomic Health® Oncotype DX® Prostate Cancer Assay	10/5/15	11/14/19	11/4/19	Active	0047U	A56976 – Billing and Coding: MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
L36048	MolDX: HLA-B*15:02 Genetic Testing	10/5/15	11/7/19	10/28/19	Active	81381	A56979 – Billing and Coding: MolDX: HLA-B*15:02 Genetic Testing
L36485	MolDX: HLA-DQB1*06:02 Testing for Narcolepsy	2/15/16	12/26/19	12/20/19	Active	81383	A56881 – Billing and Coding: MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
L37903	MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer	5/13/19	3/5/20	3/25/20	Active	81479	A56982 – Billing and Coding: MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer
L37608	MolDX: MDS FISH	5/6/19	11/7/19	3/25/20	Active	88271, 88273, 88274, 88275, 88291	A56926 – Billing and Coding: MolDX: MDS FISH
L36113	MolDX: MGMT Promoter Methylation Analysis	10/5/15	11/21/19	12/27/19	Active	81287	A56983 – Billing and Coding: MolDX: MGMT Promoter Methylation Analysis
L36011	MolDX: Molecular RBC Phenotyping	10/5/15	11/7/19	10/28/19	Active	0001U	A56986 – Billing and Coding: MolDX: Molecular RBC Phenotyping
L37348	MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels	12/3/18	11/28/19	11/21/19	Active	Group 1: 87631, 0098U, 0099U, 0100U, 0115U Group 2: 87632, 87633	A56974 – Billing and Coding: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
L37907	MolDX: myPath Melanoma Assay	6/3/19	10/31/19	3/25/20	Active	81479, 0090U	A56878 – Billing and Coding: MolDX: myPath Melanoma Assay
L35442	MolDX: NRAS Genetic Testing	10/1/15	11/28/19	11/21/19	Active	81311, 81479	A56998 – Billing and Coding: MolDX: NRAS Genetic Testing
L37836	MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)	3/25/19	11/21/19	1/23/20	Active	81479	A57003 – Billing and Coding: MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)
L36951	MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health®)	3/6/17	11/28/19	11/21/19	Active	0045U	A56887 – Billing and Coding: MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
L37354	MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer	3/6/18	11/14/19	3/25/20	Active	0047U	A56976 – Billing and Coding: MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
L36908	MolDX: Percepta® Bronchial Genomic Classifier	3/13/17	11/28/19	11/21/19	Active	81479	A56972 – Billing and Coding: MolDX: Percepta® Bronchial Genomic Classifier
L36002	MolDX: Prolaris® Prostate Cancer Genomic Assay	10/5/15	11/7/19	10/28/19	Active	81541	A57303 – Billing and Coding: MolDX: Prolaris™ Prostate Cancer Genomic Assay
L37142	MolDX: Prolaris® Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease	7/10/17	10/31/19	10/24/19	Active	81541	A56925 – Billing and Coding: MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
L37352	MolDX: Prometheus IBD sgi Diagnostic Policy	11/6/17	11/14/19	11/5/19	Active	81479, 82397, 83520, 86140	A56940 – Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy
L36021	Molecular Diagnostic Tests (MDT)	10/1/15	12/19/19	12/11/19	Active	Group 1: 81105, 81106, 8110,7 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161 - 81364 81400, 81402, 81404, 81405, 81408, 81410, 81411, 81413 - 81595 81599, 84999, 85999, 86152, 86153, 86849, 87999, 0004M, 0006M, 0007M, 0011M, 0012M, 0013M, 0001U, 0003U, 0005U, 0009U, 0012U, 0013U, 0014U, 0016U, 0017U, 0018U, 0019U, 0021U, 0022U, 0023U, 0024U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0036U, 0037U, 0039U, 0040U, 0045U - 0050U 0053U - 0060U 0062U, 0067U, 0068U, 0070U - 0076U, 0078U - 0080U 0083U, 0084U, 0087U - 0092U 0094U, 0101U - 0103U 0105U, 0107U, 0108U, 0111U, 0113U, 0114U, 0118U, 0120U, 0129U - 0132U, 0134U - 0138U, 0153U - 0162U Group 2: 81401, 81403, 80406, 81407, 81412	Click to expand the full list of related policy articles A55716 – Billing and Coding: MolDX: Abbott RealTime IDH1 and IDH2 testing for Acute Myeloid Leukemia (AML) A54243 – Billing and Coding: MolDX: CHD7 Gene Analysis Guidelines A54241 – Billing and Coding: MolDX: 4q25-AF Risk Genotype Guidelines A54242 – Billing and Coding: MolDX: 9p21 Genotype Test A54185 – Billing and Coding: MolDX: Afirma™ Assay by Veracyte Update A54186 – Billing and Coding: MolDX: AlloMap A54244 – Billing and Coding: MolDX: ApoE Genotype A54253 – Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency(ASPA) Testing A54254 – Billing and Coding: MolDX: ATP7B Gene Tests A54187 – Billing and Coding: MolDX: Avise PG Assay A54255 – Billing and Coding: MolDX: BCKDHB Gene Test A54188 – Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® A54256 – Billing and Coding: MolDX: BLM Gene Analysis A54257 – Billing and Coding: MolDX: BluePrint® Test A54258 – Billing and Coding: MolDX: CFTR Gene Analysis A54189 – Billing and Coding: MolDX: cobas® EGFR Mutation Test Guidelines A54260 – Billing and Coding: MolDX: CYP2B6 Test A54262 – Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests A54263 – Billing and Coding: MolDX: FANCC Genetic Testing A54191 – Billing and Coding: MolDX: FDA-Approved BRAF Tests A54192 – Billing and Coding: MolDX: FDA-Approved EGFR Tests A54264 – Billing and Coding: MolDX: Fragile X A54265 – Billing and Coding: MolDX: GBA Genetic Testing A54266 – Billing and Coding: MolDX: HAX1 Gene Sequencing A54267 – Billing and Coding: MolDX: HBB Gene Tests A54193 – Billing and Coding: MolDX: HERmark® Assay by Monogram A54268 – Billing and Coding: MolDX: HEXA Gene Analysis 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 A54273 – Billing and Coding: MolDX: know error® A54274 – Billing and Coding: MolDX: L1CAM Gene Sequencing Guidelines A54275 – Billing and Coding: MolDX: LPA-Aspirin Genotype A54276 – Billing and Coding: MolDX: LPA-Intron 25 Genotype A54194 – Billing and Coding: MolDX: MammaPrint A54277 – Billing and Coding: MolDX: MCOLN1 Genetic Testing Guidelines A54278 – Billing and Coding: MolDX: MECP2 Genetic Testing A54288 – Billing and Coding: MolDX: Mitochondrial Nuclear Gene Tests Guidelines A54209 – Billing and Coding: MolDX: MMACHC Test A56973 – Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) A54290 – Billing and Coding: MolDX: myPap™ A54291 – Billing and Coding: MolDX: NSD1 Gene Tests A54292 – Billing and Coding: MolDX: OncoCee™ A54195 – Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay A54196 – Billing and Coding: MolDX: Oncotype DX® Colon Cancer Guidelines A54293 – Billing and Coding: MolDX: PAX6 Gene Sequencing Guidelines A54295 – Billing and Coding: MolDX: PIK3CA Gene Tests A54296 – Billing and Coding: MolDX: PreDx® A54197 – Billing and Coding: MolDX: Progensa® PCA3 Assay Coverage Update A54297 – Billing and Coding: MolDX: PTCH1 Gene Testing A54198 – Billing and Coding: MolDX: ResponseDX Tissue of Origin® A54299 – Billing and Coding: MolDX: RPS19 Gene Tests A54300 – Billing and Coding: MolDx: SEPT9 Gene Test A54286 – Billing and Coding: MolDX: SLCO1B1 Genotype A54285 – Billing and Coding: MolDX: SMPD1 Genetic Testing A54284 – Billing and Coding: MolDX: STAT3 Gene Testing A54283 – Billing and Coding: MolDX: SULT4A1 Genetic Testing A54282 – Billing and Coding: MolDX: TERC Gene Tests A54199 – Billing and Coding: MolDX: Therascreen® EGFR RGQ PCR Kit Guidelines A54200 – Billing and Coding: MolDX: therascreen® KRAS PCR Kit Guidelines A54281 – Billing and Coding: MolDX: TP53 Gene Test A54280 – Billing and Coding: MolDX: UGT1A1 Gene Analysis A54201 – Billing and Coding: MolDX: Vectra™ DA A54279 – Billing and Coding: MolDx: VEGFR2 Tests A54830 – Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268)
L34171	Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation	10/1/15	9/26/19	9/19/19	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	10/31/19	4/30/20	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	10/24/19	10/15/194/30/20	Active	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
L34045	Non-Invasive Vascular Studies	10/1/15	11/28/19	11/21/19	Active	Group 1: 93880, 93882, 93886, 93888, 93892, 93893 Group 2: 93922, 93923, 93924, 93925, 93926, 93930, 93931 Group 3: 93970, 93971 Group 4: 93975, 93976, 93978, 93979 Group 5: 93985, 93986, 93990	A56697 – Billing and Coding: Non-Invasive Vascular Studies
L34393	Ocular Photography - External	10/1/15	10/31/19	10/24/19	Active	92285	A57068 – Billing and Coding: Ocular Photography – External
L34175	Ophthalmic Angiography (Fluorescein and Indocyanine Green)	10/1/15	10/31/19	10/24/19	Active	92235, 92240	A57069 – Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green)
L34181	Ophthalmic Biometry for Intraocular Lens Power Calculation	10/1/15	12/5/19	11/26/19	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	12/5/19	11/27/19	Active	92201, 92202, 92227, 92228, 92250	A57071 – Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
L34049	Outpatient Physical and Occupational Therapy Services	10/1/15	11/14/19	11/6/19	Active	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	A57067 – Billing and Coding: Outpatient Physical and Occupational Therapy Services
L34353	Outpatient Psychiatry and Psychology Services	10/1/15	11/7/19	10/29/19	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, 96136, 96137, 96138, 96139, 96146	A57065 – Billing and Coding: Outpatient Psychiatry and Psychology Services
L34064	Panretinal (Scatter) Laser Photocoagulation	10/1/15	10/3/19	2/24/20	Active	61882	A56594 – Billing and Coding: Panretinal (Scatter) Laser Photocoagulation
L36902	Polysomnography and Other Sleep Studies	3/6/17	9/26/19	9/20/19	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
L34085	Post-Void Residual Urine and/or Bladder Capacity by Ultrasound	10/1/15	10/1/16	9/20/19	Active	51798	A57050 – Billing and Coding: Post-Void Residual Urine and / or Bladder Capacity by Ultrasound
L36658	Proton Beam Therapy	10/24/16	9/26/19	9/23/19	Active	77520, 77522, 77523, 77525	A55315 – Billing and Coding: Proton Beam Therapy
L34183	Psychiatric Inpatient Hospitalization	10/1/15	9/26/19	2/24/20	Active	NA	A57052 – Billing and Coding: Psychiatric Inpatient Hospitalization
L34196	Psychiatric Partial Hospitalization Programs	10/1/15	11/7/19	2/24/20	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	11/28/19	2/24/20	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	12/5/19	11/27/19	Active	86001, 86003, 86005	A57043 – Billing and Coding: RAST Type Tests
L34200	Removal of Benign Skin Lesions	10/1/15	9/26/19	9/16/19	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
L36469	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder	2/8/16	12/26/19	12/19/19	Active	90867, 90868, 90869	A57047 – Billing and Coding: Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder
L34246	Routine Foot Care and Debridement of Nails	10/1/15	11/28/19	11/20/19	Active	11055, 11056, 11057, 11719, 11720, 11721, G0127	A57193 – Billing and Coding: Routine Foot Care and Debridement of Nails
L34061	Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)	10/1/15	10/3/19	9/23/19	Active	92133, 92134	A56692 – Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
L35906	Somatosensory Testing	10/1/15	9/26/19	3/25/20	Active	95925, 95926, 95927, 95928	A57041 – Billing and Coding: Somatosensory Testing
L35986	Special Histochemical Stains and Immunohistochemical Stains	10/1/15	10/31/19	12/27/19	Active	88312, 88313, 88341, 88342, 88344, 88360, 88361	A56536 – Billing and Coding: Special Histochemical Stains and Immunohistochemical Stains
L34046	Speech-Language Pathology	10/1/15	9/26/19	9/20/19	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	9/26/19	9/23/19	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	9/26/19	9/23/19	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
L34084	Transcatheter Infusion Therapy	10/1/15	12/5/19	11/27/19	Active	61650, 61651	A56811 – Billing and Coding: Transcatheter Infusion Therapy
L34337	Transesophageal Echocardiography (TEE)	10/1/15	9/26/19	9/23/19	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	9/26/19	9/26/19	Active	94014, 94015, 94016	A56808 – Billing and Coding: Transtelephonic Spirometry
L34338	Transthoracic Echocardiography (TTE)	10/1/15	9/26/19	9/26/19	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)
L34056	Urodynamics	10/1/15	9/26/19	9/26/19	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	9/26/19	9/26/19	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
L34055	Virtual Colonoscopy (CT Colonography)	10/1/15	9/26/19	9/26/19	Active	Group 1: 74261, 74262 Group 2: 74263	A56800 – Billing and Coding: Virtual Colonoscopy (CT Colonography)
L34394	Visual Fields Testing	10/1/15	9/26/19	9/26/19	Active	92081, 92082, 92083	A56799 – Billing and Coding: Billing and Coding for Visual Fields Testing
L33996	Vitamin D Assay Testing	10/1/15	11/28/19	11/20/19	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	10/31/19	10/22/19	Active	15002, 15003, 15004, 15005, 15040, 15050, 15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, C5271, C5272, C5273, C5274, C5275, C5276, C5277, C5278	A56696 – Billing and Coding: Wound Application of Cellular and / or Tissue Based Products (CTPs), Lower Extremities

Updated: 04.09.20

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