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Retired LCDs (Local Coverage Determinations) and Articles

In the absence of a LCD (Local Coverage Determination), NCD (National Coverage Determination), or CMS Manual Instruction, Reasonable and Necessary guidelines still apply.

As published in CMS IOM 100-08, Chapter 13, Section 13.5.1, in order to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:

Safe and effective.
Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, that meet the requirements of the Clinical Trials NCD are considered reasonable and necessary).
Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient's condition or to improve the function of a malformed body member.
Furnished in a setting appropriate to the patient's medical needs and condition.
Ordered and furnished by qualified personnel.
One that meets, but does not exceed, the patient's medical needs.
At least as beneficial as an existing and available medically appropriate alternative.

For any service reported to Medicare, it is expected that the medical record documentation clearly demonstrates that the service meets all of the above criteria. All documentation must be maintained in the patient’s medical record and be available to the contractor upon request.

Not finding what you are looking for? Try the MCD (Medicare Coverage Database) Archive.

ACTIVE | DRAFT | RETIRED | Update History

Title

LCD #

Article #

Retirement Date

3D Interpretation and Reporting of Imaging Studies

L34709

 

09/30/2015

Acute Care: Inpatient, Observation and Treatment Room Services

 

A47796

09/30/2015

Allergen Immunotherapy

L35759

 

09/30/2015

Allergy Testing

L35771

 

09/30/2015

Ambulance Services (Ground Ambulance)

L32606

 

09/30/2015

Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters

L33140

 

09/30/2015

Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds

L27549

A54115

09/30/2015

Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents

 

A52018

09/30/2015

Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents [ICD-10]

 

A53048

01/01/2016

Assays for Vitamins and Metabolic Function

L32614

 

09/30/2015

Autonomic Function Tests

L34788

 

09/30/2015

Bariatric Surgical Management of Morbid Obesity

L32619

 

09/30/2015

Barium Swallow Studies, Modified

L34747

 

09/30/2015

Benign Skin Lesions

L32668

 

09/30/2015

Benign Skin Lesions [ICD-10]

L34966

 

01/31/2017

Biomarkers for Oncology

L34796

A52317

09/30/2015

Biomarkers Overview

L33638

 

09/30/2015

Blood Glucose Monitoring in a Skilled Nursing Facility (SNF)

L27475

 

09/30/2015

Capsaicin Patch

 

A50870

09/30/2015

Capsaicin Patch
[ICD-10]

 

A53122

07/26/2017

Cardiac Event Detection Monitoring

L32679

 

09/30/2015

Cardiac Rhythm Device Evaluation

L30529

 

09/30/2015

Cardiovascular Nuclear Medicine

L32635

 

09/30/2015

Cataract Extraction (including Complex Cataract Surgery)

L32690

 

09/30/2015

Chiropractic Services

L34816

A47798

09/30/2015

Co-Management of Surgical Procedures

L27481

 

09/30/2015

Compounded Drugs Used in an Implantable Infusion Pump

See Implantable Infusion Pump

A54099

09/30/2015

Cosmetic and Reconstructive Surgery

L32763

 

09/30/2015

Coverage of Services and Procedures in Nursing Facilities

L27485

 

09/30/2015

Coverage of Services and Procedures in Nursing Facilities
[ICD-10]

L34863

 

07/13/2017

Debridement of Mycotic Nails

L27487

 

09/30/2015

Diagnostic Abdominal Aortography and Renal Angiography

L32709

 

09/30/2015

Evaluation and Management Services Provided in a Nursing Facility

L27496

 

09/30/2015

Facet Joint Injections

L32707

 

09/30/2015

Flow Cytometry

L32730

 

09/30/2015

Frequency of Dialysis

L32755

 

09/30/2015

Frequency of Laboratory Tests

L32731

 

09/30/2015

Glaucoma Treatment with Aqueous Drainage Device

L32733

 

09/30/2015

Glaucoma Treatment with Aqueous Drainage Device [ICD-10]

L35087

 

08/11/2016

Hemophilia Factor Products

L33658

 

09/30/2015

Hyaluronan Acid Therapies for Osteoarthritis of the Knee

L32237

 

09/30/2015

Hydration Therapy

L32738

 

09/30/2015

Hyperbaric Oxygen (HBO) Therapy

L32739

 

09/30/2015

In Vitro Chemosensitivity & Chemoresistance Assays [ICD-10]

L36055

 

Placed on Hold - Retired

Implantable Infusion Pump

L33115

See Compounded Drugs Used in an Implantable Infusion Pump

09/30/2015

Independent Diagnostic Testing Facility (IDTF)

L34792

A53186

09/30/2015

Infrared Photocoagulation (IRC) of Hemorrhoids

L34350

 

09/30/2015

Interventional Cardiology

L32603

 

09/30/2015

Intraoperative Neurophysiological Testing

L32605

 

09/30/2015

Intravenous Immune Globulin (IVIG)

L32712

 

09/30/2015

Isolated Ultrafiltration for Management of Fluid Overload in Cardiac Disease

 

A51037

09/30/2015

Lacrimal Punctum Plugs

L32607

 

09/30/2015

Lower Extremity Major Joint Replacement (Hip and Knee)

L35594

 

09/30/2015

Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

L32610

 

09/30/2015

Magnetic Pelvic Floor Stimulation (MPFS)

L34612

 

09/30/2015

Magnetic Pelvic Floor Stimulation (MPFS) [ICD-10]

L35390

 

08/11/2016

Magnetic Resonance Angiography (MRA)

L31399

 

09/30/2015

Medicine: Neurophysiology Evoked Potentials (NEPs)

L32640

 

09/30/2015

Microvascular Therapy (MVT)

 

A54342

09/30/2015

Moh’s Micrographic Surgery

L32627

A53852

09/30/2015

Molecular Diagnostics: Genitourinary Infectious Disease Testing

L33644

 

09/30/2015

Monitored Anesthesia Care

L32628

 

09/30/2015

Multiple Imaging in Oncology

L34790

 

09/30/2015

NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions

 

A47551

09/30/2015

NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions

 

A49325

09/30/2015

Nerve Conduction Studies and Electromyography

L32723

A54094

09/30/2015

Neuromuscular Junction Testing

L33650

 

09/30/2015

Non-Coronary Vascular Stents

L32641

 

09/30/2015

Non-Invasive Cerebrovascular Arterial Studies

L34711

A47800

09/30/2015

Non-Invasive Peripheral Venous Studies

L34714

A47801

09/30/2015

Non-Vascular Extremity Ultrasound

L34716

 

09/30/2015

Oral Maxillofacial Prosthesis

L32643

 

09/30/2015

Outpatient Sleep Studies

L32711

 

09/30/2015

Oximetry Services

L34749

 

09/30/2015

Pain Management

L32702

 

09/30/2015

Pain Management
[ICD-10]

L35033

 

02/01/2017

Pain Management of Peripheral Nerves by Injection

L33604

 

09/30/2015

Partial Hospitalization Programs (PHPs) – Psychiatric

L32705

 

09/30/2015

Pharmacokinetic (PK) Testing for Chemotherapy Dosing

L35269

 

09/30/2015

Prepackaged Kits

 

A54514

09/30/2015

Prostate Mapping Biopsy

L32665

 

09/30/2015

Psychiatric Codes

L32766

 

09/30/2015

Pulmonary Function Testing

L34751

 

09/30/2015

Qualitative Drug Testing

L34352

 

09/30/2015

Real-Time, Outpatient Cardiac Telemetry

L33075

A51214

09/30/2015

Routine Foot Care

L27486

A51184

09/30/2015

Sacral Nerve Stimulation

L34707

 

09/30/2015

Scanning Computerized Ophthalmic Diagnostic Imaging

L33590

 

09/30/2015

Self-Administered Drug Exclusion List

 

A51866

09/30/2015

Services That Are Not Reasonable and Necessary

L31686

 

09/30/2015

Speech-Language Pathology (SLP) Services: Communication Disorders

L27531

A54110

09/30/2015

Speech-Language Pathology (SLP) Services: Dysphagia, Includes VitalStim® Therapy

L27537

 

09/30/2015

Spinal Cord Stimulation (Dorsal Column Stimulation)

L34705

 

09/30/2015

Surgery: Blepharoplasty

L32715

 

09/30/2015

Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control

L32751

 

09/30/2015

Surgical Treatment of Nails

L27532

A47803

09/30/2015

Therapy Services (PT, OT, SLP)

L32710

 

09/30/2015

Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

L32673

 

09/30/2015

Thrombolytic Agents

L34743

 

09/30/2015

Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression

L33660

 

09/30/2015

Transesophageal Echocardiography (TEE)

L32674

 

09/30/2015

Transoral Incisionless Fundoplication

L32932

 

09/30/2015

Transthoracic Echocardiography (TTE)

L32675

 

09/30/2015

Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities

L32678

 

09/30/2015

Trigger Point Injections

L33648

 

09/30/2015

Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

L34745

 

09/30/2015

Vascular Access for Hemodialysis

L32708

 

09/30/2015

Vascular Access for Hemodialysis [ICD-10]

L35064

 

12/31/2016

Vertebroplasty Vertebral Augmentation (Kyphoplasty) Percutaneous

L32685

 

09/30/2015

Vestibular and Audiologic Function Studies

L32767

 

09/30/2015

Wireless Capsule Endoscopy

L32686

 

09/30/2015

Wound Care

L32687

 

09/30/2015


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Last modified:  09/13/2017