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New York and Connecticut Retired Local Coverage Determinations (LCDs) - November 14, 2008




The National Government Services, Inc. local coverage determinations (LCDs) listed below are being retired effective November 14, 2008 for the states of New York and Connecticut, (MAC Jurisdiction-13) The retired LCDs listed in the first table below will be replaced by new National Government Services-wide policies that are effective November 15, 2008 and are also listed in the table.

New York/Connecticut (J-13) LCD being retired 11/14/2008 LCD Number National Government Services LCD replacing J-13 LCD – effective 11/15/2008
Audiological/Vestibular Function Tests L28190 L27390
Chiropractic Services L28144 L27350
Debridement Services L28205 L27373
Electrocardiogram (ECG or EKG) L28189 L27427
Erectile Dysfunction, Evaluation and Treatment L28127 L27371
Flow Cytometry L28123 L27386
Immunocytochemistry L28143 L27348 (Immunohistochemistry)
Laser Ablation of the Prostate L28128 L27369
Lipid Profile/Cholesterol Testing L28125 L27352
Noninvasive Vascular Diagnostic Studies L28166 L27355
Ocular Photography – External L28177 L27383
Prostate Specific Antigen (PSA) L28146 L27357
Removal of Benign Skin Lesions L28140 L27362
Serum Magnesium L703 (Part A) L27375
Serum Magnesium L28136 L27375
Stress Echocardiography L28139 L27360 (Transthoracic Echocardiography TTE)
Swallow Evaluation L686 (Part A) L27364 (Swallow Evaluation and Dysphagia)
Swallow Evaluation/Dysphagia L28208 L27364 (Swallow Evaluation and Dysphagia)
Transesophageal Echocardiography (TEE) L28162 L27381
Transthoracic Echocardiography (TTE) L28169 L27360

The second group of LCDs is being retired effective November 14, 2008, and will not be replaced by new LCDs at this time. For all services, whether included in an LCD or not, CMS national policy rules, requirements and limitations remain in effect.

New York/Connecticut (J-13) LCD being retired 11/14/2008 LCD Number
Cardiac Electrophysiology Services (EPS) L28171
Chelation Therapy L28172
Endothelial Cell Photography L28175
General Ophthalmologic Services L28184
Gonioscopy L28185
Helicobacter Pylori (H. Pylori) Tests L28141
Morphometric Analysis L28132
Pulmonary Function Testing L622 (Part A)
Pulse Oximetry L2205 (Part A)
Pulse Oximetry L28180
Rehabilitation for Patients with Visual Impairment L28181
Respiratory Therapy Services L28124
Troponin Testing L672 (Part A)
Troponin Testing L28173
Unna Boot L28182


Posted 11/03/08

CPT codes, descriptions, and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.

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