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
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 When using the individual links provided below there may be times that you will receive the message "superseded", indicating you are not viewing the most current LCD.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 If you get the note "superseded" on a policy, please use the main link listed below for current LCDs to the MCD provided while we complete the process of updating the individual links.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.
- Current Kentucky Part A Local Coverage Determinations
- Current Kentucky Part A Coverage Articles
- Future Kentucky Part A LCDs
- Draft Kentucky Part A LCDs
- Current Ohio Part A Local Coverage Determinations
- Current Ohio Part A Coverage Articles
- Future Ohio Part A LCDs
- Draft Ohio Part A LCDs
- Medicare Coverage Database Archived Local Coverage Determinations
- SE1421 How to Access Updates to ICD-10 Local Coverage Determinations in the CMS Medicare Coverage Database
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 | 10/7/20 | 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 | 11/16/20 | Active | 83880 | A56425 – Billing and Coding: B-type Natriuretic Peptide (BNP) Testing![]() |
L36975![]() |
Bladder/Urothelial Tumor Markers | 3/6/17 | 3/4/21 | 3/4/21 | Active | 86294, 86316, 86386, 88120, 88121 | A56471 – Billing and Coding: Bladder / Urothelial Tumor Markers![]() |
L33944![]() |
Blepharoplasty | 10/1/15 | 11/7/19 | 10/21/20 | 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 | 12/24/20 | 12/17/20 | 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 | 11/16/20 | 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 | 11/28/19 | 11/16/20 | 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 | 10/19/20 | 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 | 10/19/20 | 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 | 9/30/20 | 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 | 11/16/20 | Active | 93228, 93229, 93268,93270, 93271 , 93272, 93799 | A56452 – Billing and Coding: Cardiac Event Detection![]() |
L33960![]() |
Cardiovascular Nuclear Medicine | 10/1/15 | 2/4/21 | 1/27/21 | 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 | 12/24/20 | 12/17/20 | Active | 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984 | A56453 – Billing and Coding: Cataract Extraction![]() |
L33945![]() |
Cerumen (Earwax) Removal | 10/1/15 | 2/4/21 | 1/27/21 | Active | 69209, 69210, G0268 | A56454 – Billing and Coding: Cerumen (Earwax) Removal![]() |
L37254![]() |
Chiropractic Services | 11/6/17 | 2/4/21 | 1/27/21 | Active | 98940, 98941, 98942 | A56455 – Billing and Coding: Chiropractic Services![]() |
L37126![]() |
Coenzyme Q10 (CoQ10) | 7/10/17 | 2/25/21 | 2/25/21 | Active | 82542 | A55715 – Billing and Coding: Coenzyme Q10 (CoQ10)![]() |
L38777![]() |
Colon Capsule Endoscopy (CCE) | 3/29/21 | NA | 2/5/21 | Active | 0355T | A58362 – Billing and Coding: Colon Capsule Endoscopy![]() |
L34005![]() |
Colonoscopy/Sigmoidoscopy/ Proctosigmoidoscopy | 10/1/15 | 2/4/21 | 1/27/21 | 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 | 2/4/21 | 1/27/21 | Active | 92025 | A56816 – Billing and Coding: Computerized Corneal Topography![]() |
L36029![]() |
Controlled Substance Monitoring and Drugs of Abuse Testing | 10/5/15 | 3/8/21 | 1/15/21 | Active | 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659, 0143U, 0144U, 0145U, 0146U, 0147U, 0148U, 0149U, 0150U 0227U | A56818 – Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing![]() |
L33999![]() |
Corneal Pachymetry | 10/1/15 | 1/28/21 | 1/22/21 | Active | 76514 | A56457 – Billing and Coding: Billing and Coding for Corneal Pachymetry![]() |
L34032![]() |
Debridement Services | 10/1/15 | 9/12/19 | 9/30/20 | Active | 11000, 11001, 11042, 11043, 11044, 11045, 11046, 11047 | A56459 – Billing and Coding: Debridement Services![]() |
L34062![]() |
Dialysis Access Maintenance | 10/1/15 | 1/28/21 | 1/22/21 | 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 | 3/4/21 | 2/24/21 | Active | Group 1: 91110 Group 2: 91111, 91299 |
A56461 – Billing and Coding: Endoscopy by Capsule![]() |
L34356![]() |
Erythropoiesis Stimulating Agents (ESA) | 10/1/15 | 3/4/21 | 2/24/21 | 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 | NA | 3/10/21 | Future | 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 ![]() |
L34832![]() |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy | 10/1/15 | 12/31/20 | 12/22/20 | 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 | 3/4/21 | 2/24/21 | 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 | 3/25/21 | 3/19/21 | 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 | 3/4/21 | 2/25/21 | Active | Group 1: 87505, 87506, 0097U Group 2: 87507 |
A56596 – Billing and Coding: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs)![]() |
L37575 ![]() |
Frequency of Hemodialysis | 4/1/19 | 1/28/21 | 1/22/21 | Active | 90999 | A56159 – Billing and Coding: Frequency of Hemodialysis![]() |
L36906![]() |
GlycoMark Testing for Glycemic Control | 3/6/17 | 3/25/21 | 3/19/21 | Active | 84378, 84999 | A56465 – Billing and Coding: GlycoMark Testing for Glycemic Control![]() |
L34089![]() |
Human Papillomavirus (HPV) Testing | 10/1/15 | 4/1/2021 | 3/23/21 | Active | 87623, 87624 | A56466 – Billing and Coding: Human Papillomavirus (HPV) Testing![]() |
L38307![]() |
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea | 4/1/20 | 3/25/21 | 3/19/21 | Active | 64568, 0466T, 0467T, 0468T | A57149 – Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea![]() |
L38268![]() |
Immune Thrombocytopenia (ITP) Therapy | 4/1/20 | 3/4/21 | 2/24/21 | 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![]() |
L38662![]() |
Implantable Continuous Glucose Monitors (I-CGM) | 11/2/20 | NA | 9/11/20 | Active | 0446T, 0447T, 0448T | A58127 – Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) ![]() |
L35891![]() |
Intravenous Immune Globulin | 10/1/15 | 4/1/21 | 3/23/21 | 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 | 4/1/21 | 3/23/21 | Active | 52647, 52648, 52649 | A56467 – Billing and Coding: Laser Ablation of the Prostate![]() |
L34807![]() |
Lumbar Epidural Steroid Injections (ESI) | 10/1/15 | 12/31/20 | 12/22/20 | 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 | 3/8/21 | 1/15/21 | Active | 0398T | A58323 – Billing and Coding: Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions![]() |
L37578![]() |
Micro-Invasive Glaucoma Surgery (MIGS) | 3/19/18 | 12/30/18 | 3/25/20 | Active | Group 1: 0191T 0376T Group 2: 0449T 0450T Group 3: 0253T, 0474T |
A56491 – Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)![]() |
L36494![]() |
Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint | 2/1/16 | 12/24/20 | 12/17/20 | 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 | 4/30/20 | Active | 17311, 17312, 17313, 17314, 17315 | A56836 – Billing and Coding: Mohs Micrographic Surgery![]() |
L36979![]() |
MolDX: 4Kscore Assay | 3/13/17 | 4/1/21 | 3/26/21 | Active | 81539 | A56944 – Billing and Coding: MolDX: 4Kscore Assay![]() |
L38272 ![]() |
MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts | 12/28/20 | NA | 11/4/20 | Active | Group 1 81479 Group 2 81479 |
A57167 – Billing and Coding: MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts ![]() |
L37836![]() |
MolDX: Androgen Receptor Variant (AR-V7) Protein Test | 3/25/19 | 5/9/21 | 3/19/21 | Future | 81479 | A57158 – Billing and Coding: MolDX: Androgen Receptor Variant (AR-V7) Protein Test![]() |
L36910![]() |
MolDX: APC and MUTYH Gene Testing | 3/13/17 | 4/1/21 | 3/26/21 | 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 | 11/19/20 | 11/16/20 | Active | 0080U | A56947 – Billing and Coding: MolDX: BDX-XL2![]() |
L38249![]() |
MolDX: Blood Product Molecular Antigen Typing | 11/1/20 | 12/10/20 | 12/1/20 | Active | Group 1 21403, 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 ![]() |
L36139![]() |
MolDX: Biomarkers in Cardiovascular Risk Assessment | 10/5/15 | 11/14/19 | 6/19/20 | 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 | 12/24/20 | 12/18/20 | Active | Group 1: 81162, 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 | 8/25/20 | Active | 81520 | A56989 – Billing and Coding: MolDX: Breast Cancer Assay: Prosigna![]() |
L37832![]() |
MolDX: Breast Cancer™ (BCI) Gene Expression Test | 4/1/19 | 5/2/21 | 3/22/21 | Future | 81518 | A56884 – Billing and Coding: MolDX: Breast Cancer Index™ (BCI) Gene Expression Test![]() |
L36006![]() |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay | 10/5/15 | 12/17/20 | 12/11/20 | Active | 81551 | A57031 – Billing and Coding: MolDX: ConfirmMDx Epigenetic Molecular Assay![]() |
L36675![]() |
MolDX - CDD: ProMark Risk Score | 10/10/16 | 11/28/19 | 10/21/20 | 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 | 11/16/20 | Active | 81493 | A56950 – Billing and Coding: MolDX: Corus® CAD Assay![]() |
L37598![]() |
MolDX: Cystatin C Measurement | 12/17/18 | 12/10/20 | 12/1/20 | Active | 82610 | A56988 – Billing and Coding: MolDX: Cystatin C Measurement![]() |
L38016![]() |
MolDX: Melanoma Risk Stratification Molecular Testing | 6/24/19 | 12/21/20 | 10/26/20 | Active | 81529, 81599 | A57165 – Billing and Coding: MolDX: Melanoma Risk Stratification Molecular Testing![]() |
L37130![]() |
MolDX: DecisionDx-UM (Uveal Melanoma) | 7/10/17 | 10/31/19 | 5/27/20 | 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![]() |
L36117![]() |
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease | 10/5/15 | 12/19/19 | 6/30/20 | 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 | 6/30/20 | 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 | 11/16/20 | 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 ![]() |
L36485![]() |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy | 2/15/16 | 12/24/20 | 12/18/20 | 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 | 6/4/20 | 5/26/20 | Active | 81287 | A56983 – Billing and Coding: MolDX: MGMT Promoter Methylation Analysis![]() |
L38305![]() |
MolDX: Minimal Residual Disease Testing for Colorectal Cancer | 10/19/20 | NA | 8/26/20 | Active | 81479 | A58330 - Billing and Coding: MolDX: Minimal Residual Disease Testing for Colorectal Cancer ![]() |
L37348![]() |
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels | 12/3/18 | 11/30/20 | 12/14/20 | Active | Group 1: 87631, 87636, 87637, 0240U, 0241U Group 2: 87632, 87633, 0098U, 0099U, 0100U, 0115U, 0151U, 0202U, 0223U, 0225U |
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![]() |
L38067![]() |
MolDX: Next-Generation Sequencing for Solid Tumors | 2/10/20 | 3/5/20 | 3/12/20 | Active | 81445, 81479 | 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 | 3/5/20 | 3/12/20 | Active | 81450, 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 | 11/28/19 | 1130/20 | Active | 81311, 81479 | A56998 – Billing and Coding: MolDX: NRAS Genetic Testing![]() |
L36951![]() |
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health®) | 3/6/17 | 11/28/19 | 11/21/20 | Active | 0045U | A56887 – Billing and Coding: MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)![]() |
L36908![]() |
MolDX: Percepta® Bronchial Genomic Classifier | 3/13/17 | 11/28/19 | 11/30/20 | Active | 81479 | A56972 – Billing and Coding: MolDX: Percepta® Bronchial Genomic Classifier![]() |
L38394![]() |
MolDX: Pharmacogenomics Testing | 8/3/20 | NA | 6/12/20 | Active | 81220, 81225, 81226, 81227, 81231, 81232, 81247, 81283, 81306, 81328, 81335, 81350, 81355, 81374, 81377, 81381, 81383, 81406, 0030U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U | A58324 - Billing and Coding: MolDX: Pharmacogenomics Testing![]() |
L38111![]() |
MolDX: Pigmented Lesion Assay | 3/30/20 | NA | 2/5/20 | Active | 0089U | A57915 - Billing and Coding: MolDX: Pigmented Lesion Assay ![]() |
L38065 ![]() |
MolDX: Plasma-Based Genomic Profiling in Solid Tumors | 7/27/20 | NA | 6/4/20 | Active | 81445, 81479 | 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 | NA | 6/4/20 | Active | 81479 | A58038 - Billing and Coding: MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer ![]() |
L36002![]() |
MolDX: Prolaris® Prostate Cancer Genomic Assay | 10/5/15 | 11/7/19 | 7/13/20 | 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 | 6/4/20 | 5/26/20 | 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 | 2/25/21 | 2/25/21 | Active | 81479, 82397, 83520, 86140 | A56940 – Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy![]() |
L38059![]() |
MolDX: Prospera | 3/10/20 | 12/24/20 | 12/18/20 | Active | 81479 | A57859 – Billing and Coding: MolDX: Prospera™![]() |
L38303![]() |
MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease | 11/9/20 | NA | 9/14/20 | 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 | NA | 4/17/20 | Active | 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81171, 81172, 81173, 81174, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81200, 81201, 81202, 81203, 81204, 81205, 81209, 81212, 81215, 81216, 81217, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81269, 81271, 81274, 81283, 81284, 81285 81286, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81302, 81303, 81304, 81306, 81312, 81317, 81318, 81319, 81321, 81322, 81323, 81324, 81325, 81326, 81328, 81329, 81330, 81331, 81332, 81333, 81335, 81336, 81337, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81448, 81460, 81465, 81470, 81471 | A57141 - Billing and Coding: MolDX: Repeat Germline Testing![]() |
L38053![]() |
MolDX: TruGraf Blood Gene Expression Test | 12/30/19 | 12/24/20 | 12/18/20 | Active | 81479 | A57446 – Billing and Coding: MolDX: TruGraf Blood Gene Expression Test![]() |
L36021![]() |
Molecular Diagnostic Tests (MDT) | 10/1/15 | 12/19/19 | 11/30/20 | Active | Group 1: 81105, 81106, 81107 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161 - 81364 81400, 81402, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81413 - 81595 81599, 84999, 85999, 86152, 86153, 86849, 87999, 88341, 88342, 88360, 88361, 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, 81406, 81407, 81412, 81443, 81445, 81479 |
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 ![]() A54685 – Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing Coding and Billing Guidelines ![]() 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 ![]() A56307 – Billing and Coding: MolDX: ClonoSEQ® Assay for Assessment of Minimal Residual Disease (MRD) in Patients with Specific Lymphoid Malignancies ![]() A54189 – Billing and Coding: MolDX: cobas® EGFR Mutation Test Guidelines ![]() 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 ![]() A54688 – Billing and Coding: MolDX: FDA-Approved KRAS 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 ![]() A54285 – Billing and Coding: MolDX: SMPD1 Genetic Testing ![]() A54284 – Billing and Coding: MolDX: STAT3 Gene Testing ![]() A54283 – Billing and Coding: MolDX: SULT4A1 Genetic Testing ![]() A54901 – Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Next Generation Sequencing Testing in Cancer ![]() 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 ![]() 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 | 5/27/20 | 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![]() |
L38771 | Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease | 04/25/21 | NA | 3/5/21 | Future | 0501T 0502T 0503T 0504T | A58359 – Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease |
L34045![]() |
Non-Invasive Vascular Studies | 10/1/15 | 11/28/19 | 10/21/20 | 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, 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 | 10/31/19 | 4/30/20 | Active | 92285 | A57068 – Billing and Coding: Ocular Photography – External![]() |
L34175![]() |
Ophthalmic Angiography (Fluorescein and Indocyanine Green) | 10/1/15 | 10/31/19 | 5/27/20 | 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 | 5/27/20 | 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 | 5/27/20 | 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 | 5/27/20 | 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 Group 2 98966, 98967, 98968, G2010, G2012, G2061, G2062, G0563 |
A57067 – Billing and Coding: Outpatient Physical and Occupational Therapy Services![]() |
L34353![]() |
Outpatient Psychiatry and Psychology Services | 10/1/15 | 11/7/19 | 5/27/20 | 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![]() |
L38201![]() |
Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) | 11/18/19 | 4/25/21 | 3/5/21 | Future | 22510, 22511, 22512, 22513, 22514, 22515 | A57282 – Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)![]() |
L34064![]() |
Panretinal (Scatter) Laser Photocoagulation | 10/1/15 | 3/4/21 | 2/24/21 | Active | 67228 | A56594 – Billing and Coding: Panretinal (Scatter) Laser Photocoagulation![]() |
L36902![]() |
Polysomnography and Other Sleep Studies | 3/6/17 | 1/28/21 | 1/22/21 | 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 | 3/4/21 | 2/24/21 | 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 | 9/30/20 | Active | 77520, 77522, 77523, 77525 | A55315 – Billing and Coding: Proton Beam Therapy![]() |
L34183![]() |
Psychiatric Inpatient Hospitalization | 10/1/15 | 3/4/21 | 2/24/21 | Active | NA | A57052 – Billing and Coding: Psychiatric Inpatient Hospitalization![]() |
L34196![]() |
Psychiatric Partial Hospitalization Programs | 10/1/15 | 3/4/21 | 2/24/21 | 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 | 3/4/21 | 2/24/21 | 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 | 7/31/20 | Active | 86001, 86003, 86005 | A57043 – Billing and Coding: RAST Type Tests![]() |
L34200![]() |
Removal of Benign Skin Lesions | 10/1/15 | 9/26/19 | 7/13/20 | 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 | 1/7/21 | 12/29/20 | 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 | 7/30/20 | 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 | 7/30/20 | Active | 92133, 92134 | A56692 – Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)![]() |
L35906![]() |
Somatosensory Testing | 10/1/15 | 4/1/21 | 3/22/21 | Active | 95925, 95926, 95927, 95928 | A57041 – Billing and Coding: Somatosensory Testing![]() |
L35986![]() |
Special Histochemical Stains and Immunohistochemical Stains | 10/1/15 | 3/4/21 | 2/24/21 | Active | NA | NA |
L34046![]() |
Speech-Language Pathology | 10/1/15 | 9/26/19 | 7/30/20 | 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 | 8/25/20 | 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 | 8/25/20 | 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 | 8/25/20 | Active | 61650, 61651 | A56811 – Billing and Coding: Transcatheter Infusion Therapy![]() |
L34337![]() |
Transesophageal Echocardiography (TEE) | 10/1/15 | 9/26/19 | 8/25/20 | 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 | 9/15/20 | Active | 94014, 94015, 94016 | A56808 – Billing and Coding: Transtelephonic Spirometry![]() |
L34338![]() |
Transthoracic Echocardiography (TTE) | 10/1/15 | 9/26/19 | 9/15/20 | 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 | 9/15/20 | 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 | 9/15/20 | 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 | 9/15/20 | Active | Group 1: 74261, 74262 Group 2: 74263 |
A56800 – Billing and Coding: Virtual Colonoscopy (CT Colonography)![]() |
L34394![]() |
Visua Search: l Fields Testing | 10/1/15 | 9/26/19 | 9/15/20 | 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 | 9/15/20 | 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 | 8/25/20 | 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: 04.07.21