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Retired Local Coverage Determinations (LCDs) and Local Coverage Articles

The following is a list of LCDs and Local Coverage Articles that have been retired.

LCDs and Articles that have been retired for less than one year remain on the Medicare Coverage Database (MCD).

LCDs and Articles that have been retired one year or more are housed on the MCD Archive.

If you do not see the LCD or Article that you are looking for in the list below, try searching the MCD Archive. Once you are on the MCD archive page, follow the steps below:

Step 1: Select Search Criteria - Document Type
Step 2: Select Search Criteria - Geographic Area and/or Contractor (Type)
Step 3: Select One or More Criteria (Keyword, CPT/HCPCS, ICD-CM Diagnosis Codes, and Date Criteria [In Effect on this Date, In Effect Between])
Click Search Now

The next page will show Search Results, which includes the archived document/s available based on the information you entered.

ACTIVE | PROPOSED | 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)

L32252

 

09/30/2015

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

L32943

 

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

 

A47797

09/30/2015

Autonomic Function Tests

L34788

 

09/30/2015

Bariatric Surgical Management of Morbid Obesity

L34495

 

09/30/2015

Barium Swallow Studies, Modified

L34747

 

09/30/2015

Biomarkers for Oncology

L34796

A52317

09/30/2015

Biomarkers Overview

L33638

 

09/30/2015

Billing and Coding Information Regarding Uses, Including Off-Label Uses, of Bevacizumab and Rantibizumab, for The Treatment of Ophthalmological Diseases

 

A49034

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

L31187

 

09/30/2015

Cardiovascular Nuclear Medicine [ICD-10]

L35085

 

12/30/2015

Cardiovascular Stress Testing

 

A47786

09/30/2015

Cardiovascular Stress Testing [ICD-10]

 

A53123

05/12/2016

Cataract Extraction
(including Complex Cataract Surgery)

L34344

 

09/30/2015

Chiropractic Services

L34816

A47798

09/30/2015

Co-Management of Surgical Procedures

L27481

A47790

09/30/2015

Compounded Drugs Used in an Implantable Infusion Pump

See Implantable Infusion Pump

A54099

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

C-Reactive Protein High Sensitivity Testing (hsCRP)

L30256

 

09/30/2015

Debridement of Mycotic Nails

L27487

 

09/30/2015

Diagnostic Abdominal Aortography and Renal Angiography

L32709

 

09/30/2015

Endovascular Repair of Aortic Aneurysms

 

A47791

09/30/2015

Evaluation and Management Services Provided in a Nursing Facility

L27496

 

09/30/2015

Flow Cytometry

L32562

 

09/30/2015

Flow Cytometry [ICD-10]

L34857

 

08/11/2016

Frequency of Dialysis

L34388

 

09/30/2015

Glaucoma Treatment with Aqueous Drainage Device

L34355

 

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

L32018

A51277

09/30/2015

Hyperbaric Oxygen (HBO) Therapy [ICD-10]

L34979

A52990

12/30/2015

In Vitro Chemosensitivity & Chemoresistance Assays

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

L30817

 

09/30/2015

Infrared Photocoagulation (IRC) of Hemorrhoids [ICD-10]

L34861

 

10/04/2018

Intraoperative Neurophysiological Testing

L27499

 

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

L34358

 

09/30/2015

Loss of Heterozygosity Based Topographic Genotyping with PathfinderTG

L31144

 

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

Microvascular Therapy (MVT)

 

A54342

09/30/2015

Moh’s Micrographic Surgery

L27503

A53852

09/30/2015

Moh’s Micrographic Surgery [ICD-10]

L35069

 

12/30/2015

Molecular Diagnostics: Genitourinary Infectious Disease Testing

L32567

 

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

NCD on Pneumatic Compression Therapy

 

A51475

09/30/2015

Nerve Conduction Studies and Electromyography

L29547

A54093

09/30/2015

Neuromuscular Junction Testing

L32239

 

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

Ophthalmic Biometry for Intraocular Lens (IOL) Power Calculation

 

A47792

09/30/2015

Oral Maxillofacial

L33654

 

09/30/2015

Oral Maxillofacial Prosthesis [ICD-10]

L35047

 

10/04/2018

Outpatient Sleep Studies

L27530

 

09/30/2015

Oximetry Services

L34749

 

09/30/2015

Pain Management of Peripheral Nerves by Injection

L32573

 

09/30/2015

Pain Management of Peripheral Nerves by Injection [ICD-10]

L35107

 

12/01/2017

Pharmacokinetic (PK) Testing for Chemotherapy Dosing

L35269

 

09/30/2015

Pharmacokinetic (PK) Testing for Chemotherapy Dosing [ICD-10]

L35679

 

10/04/2018

Physical Medicine & Rehabilitation Services, Physical Therapy and Occupational Therapy

L27513

 

09/30/2015

Physical Medicine & Rehabilitation Services, Physical Therapy and Occupational Therapy [ICD-10]

L35044

 

04/06/2016

Prepackaged Kits

 

A54514

09/30/2015

Prostate Mapping Biopsy

L33656

 

09/30/2015

Psychiatric Therapeutic Procedures

L27514

A49815

09/30/2015

Psychiatric Therapeutic Procedures [ICD-10]

L35067

A52994

12/30/2015

Pulmonary Function Testing

L34751

 

09/30/2015

Qualitative Drug Testing

L32050

 

09/30/2015

RAST Type Test

L30524

 

08/12/2015

Real-Time, Outpatient Cardiac Telemetry

L27520

A51214

09/30/2015

Removal of Benign or Premalignant Skin Lesions

L27527

 

09/30/2015

Routine Foot Care

L27486

A51184

09/30/2015

Sacral Nerve Stimulation

L34707

 

09/30/2015

Scanning Computerized Ophthalmic Diagnostic Imaging

L27529

 

09/30/2015

Self-Administered Drug Exclusion List

 

A47773

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

L34396

 

09/30/2015

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

L33083

 

09/30/2015

Surgical Treatment of Nails

L27532

A47803

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

L32055

 

09/30/2015

Transesophageal Echocardiography (TEE)

L27535

A47805

09/30/2015

Transesophageal Echocardiography (TEE) [ICD-10]

L34837

A52999

12/30/2015

Transforaminal Epidural, Paravertebral Facet and Sacroiliac Joint Injections

L27512

 

09/30/2015

Transoral Incisionless Fundoplication

L32932

 

09/30/2015

Transoral Incisionless Fundoplication [ICD-10]

L34999

 

10/25/2018

Transthoracic Echocardiography (TTE)

L27536

A47806

09/30/2015

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

L32678

 

09/30/2015

Trigger Point Injections

L27540

 

09/30/2015

Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

L34745

 

09/30/2015

Use of Vaccines or Inoculations for Treatment of Injury or Exposure

 

A47549

09/30/2015

Vascular Access for Hemodialysis

L32465

 

09/30/2015

Vascular Access for Hemodialysis [ICD-10]

L35064

 

12/31/2016

Vertebroplasty Vertebral Augmentation (Kyphoplasty) Percutaneous

L33652

 

09/30/2015

Vestibular and Audiologic Function Studies

L32767

 

09/30/2015

Vitamin D Assay Testing

L30273

 

09/30/2015

Vitamin D Assay Testing [ICD-10]

L34888

 

08/04/2016

Wireless Capsule Endoscopy

L34342

 

09/30/2015

Wound Care

L27547

A47793

09/30/2015

Wound Care [ICD-10]

L35139

 

11/09/2017


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Last modified:  01/08/2019