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  Jurisdiction 13 Transition

Local Coverage Determination (LCD) Transition for J-13 MAC

 

 

The table below lists the Local Coverage Determinations (LCDs) for the Medicare Jurisdiction 13 region that are currently in notice. These LCDs are effective for the following states and contractor types as listed below.

Contractor Type
Contract Number
Effective date for LCDs
Connecticut – Part A
13103
11/14/2008
Connecticut – Part B
13102
08/01/2008
New York – Part A
13201
11/14/2008
New York - Part B (Downstate, excluding Queens)
13202
07/18/2008
New York – Part B (Upstate)
13282
09/01/2008
New York – Part B (Queens)
13292
07/18/2008

To access the J13 LCDs, click on “Change criteria” above this article, and select Part A or Part B under Business Type, and New York or Connecticut under Region.

On the Local Coverage Determination page, select “In Notice” under Status. This will bring up the list of all J13 LCDs.

On July 18, 2008, these same LCDs will be moved to “Active” status, as the transition begins for each region.

To view the J-13 LCDs on the Medicare Coverage Database, click on this link, http://www.cms.hhs.gov/mcd/results_idsearch.aspexternal link and follow these instructions:

1. Under Local Coverage, Policies, choose Final and Draft policies
2. De-select Articles
3. Under Contractor, select National Government Services - any MAC contract number
4. Choose Date Criteria, In effect on this date: enter 07/18/2008
5. Search Now

For policies in effect prior to the J-13 transition, please refer to the National Government Services LCD pages for your state and contract.

LCD Title
Database ID from Medicare Coverage Database
Abdominal Ultrasound
L28073
Acid Phosphatase
L25879
Allergy Immunotherapy
L28138
Apheresis - Non Low Density Liproprotein & Low Density Lipoprotein
L26865
Audiologic/Vestibular Function Tests
L28190
Baclofen Intrathecal Therapy
L28196
Bariatric Surgery
L28202
Beta2 - Microglobulin
L28192
Biologic Products for Wound Treatment and Surgical Interventions
L26003
Blepharoplasty
L26448
Bone Mass Measurement
L26385
Botulinum Toxins Type A and Type B
L26841
Brachytherapy
L28149
Breast Imaging: Mammography / Breast Echography (Sonography) / Breast MRI/Ductography
L26890
B-type Natruretic Peptide (BNP) Testing
L26375
Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy
L26843
Cardiac Catherization and Coronary Angiography
L26880
Cardiac Computed Tomography (CCT) and Computed Tomography Coronary Angiography (CTCA)
L25907
Cardiac Electrophysiology Services (EPS)
L28171
Cardiac Event Detection
L26415
Cardiac Output Monitoring by Thoracic Electrical Bioimpedance
L25447
Cardiovascular Nuclear Medicine
L26859
Cataract Extraction
L26853
Category III CPT Codes
L25275
Chelation Therapy
L28172
Chiropractic Services
L28144
Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
L26404
Colorectal Cancer Screening
L26402
Computed Tomographic (CT) Colonography
L25233
Computed Tomography (CT Scans)
L28191
Computerized Corneal Topography
L28201
Computerized Dynamic Posturography
L28193
Debridement Services
L28205
Drugs and Biologicals, Coverage for Label and Off-Label Uses

Note: Many former drug policies are now articles attached to LCD L25820, Coverage of Drugs and Biologicals for Label and Off-Label Uses.
L25820
Dynamic Electrocardiography (EKG, ECG)
L26409
Electrocardiogram (ECG or EKG)
L28189
Endoscopy by Capsule
L25468
Endothelial Cell Count
L28175
Epidural/Intrathecal Injections
L28117
Erectile Dysfunction
L28127
Erythrocyte Sedimentation Rate (ESR)
L25639
Erythropoietin Stimulating Agents (ESA)
L25211
Esophagogastroduodenoscopy (EGD)
L26394
Extracorporeal Shockwave Therapy (ESWT) for Musculoskeletal Indications
L28133
Facet Joint Nerve Block
L28150
Filgrastim, Pegfilgrastim (e.g., Neupogen®, Neulasta™)
L28210
Flow Cytometry
L28123
General Ophthalmologic Services
L28184
Gonioscopy
L28185
Health and Behavior Assessment/Intervention
L28211
Helicobacter Pylori
L28141
High Sensitivity C-Reactive Protein (hsCRP) Testing
L26445
Homocysteine Level, Serum
L25650
Hyperbaric Oxygen Therapy (HBO)
L25204
Immunohistochemistry
L28143
Implanted Catheter/Pump Infusion via Intrathecal or Epidural Drug Delivery System
L28154
Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures
L28206
Independent Diagnostic Testing Facility (IDTF)
L28135
Infrared Coagulation (IRC) of Hemorrhoids
L25178
Initial Hospital Visits
L28195
Injection of Tendon Sheath
L28161
Inpatient Rehabilitation Services Provided in an Inpatient Rehabilitation Facility (IRF)
L25714
Intermittent Inotropic Infusion for the Treatment of Chronic Heart Failure in an Outpatient Setting
L26867
Interventional Cardiology
L28129
Intravascular Brachytherapy
L28152
Ionized Calcium
L28209
Laryngoscopy, Diagnostic
L28130
Laser Ablation of the Prostate
L28128
Lipid Profile/Cholersterol Testing
L28125
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
L26369
Magnetic Resonance Angiography (MRA)
L25367
Medically Necessary Removal of Impacted Cerumen
L28170
MOHS Micrographic Surgery
L26371
Morphometric Analysis
L28132
Nasal Punctum/Nasolacrimal Duct Dilation with or without Irrigation
L26872
Nerve Blocks: Transforaminal Epidural Injections
L28164
Nerve Conduction Studies (NCS)/Electromyography (EMG)
L26869
Nesiritide Infusion for Heart Failure
L26418
Neuromuscular Junction Testing
L25563
Non-Invasive Vascular Diagnostic Studies
L28166
Nonvascular Extremity Ultrasound
L28178
Ocular Blood Flow Tests
L26422
Ocular Corneal Pachymetry
L28142
Ocular Photography - External
L28177
Ophthalmic Angiography (Fluorescein and Indocyanine Green)
L25347
Ophthalmic Biometry for Intraocular Lens Power Calculation
L26441
Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
L25466
Opthalmic A and B Scans
L28174
Outpatient Physical and Occupational Therapy Services
L26884
Outpatient Psychiatry and Psychology Services
L26895
Panretinal (Scatter) Laser Photocoagulation (Legacy EMS B)
L28198
Parathormone (Parathyroid Hormone, PTH, Immunoreactive PTH) (Legacy EMS B)
L28126
Pelvic and Transvaginal Ultrasound Procedures
L28134
Polysomnography and Sleep Studies
L26428
Post-Operative Pain Management
L28187
Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
L26882
Prostate Specific Antigen (PSA)
L28146
Psychiatric Inpatient Hospitalization
L25507
Psychiatric Partial Hospitalization Programs
L26398
Psychological Services Coverage under the “Incident to” Provision for Physicians and Non-physicians
L26899
Pulmonary Function Testing
L28179
Pulse Oximetry
L28180
Qualitative Drug Screen
L28145
Radiation Therapy
L28199
Radiologic Examination of the Chest
L26901
RAST Type Tests
L28137
Rehabilitation for Patients with Visual Impairment
L28181
Removal of Benign Skin Lesions
L28140
Respiratory Therapy Services
L28124
Routine Foot Care and Debridement of Mycotic Nails
L28199
Scanning Computerized Ophthalmic Diagnostic Imaging SCODI)
L28200
Serum Magnesium
L28136
Skilled Nursing Facilities (Including Swing Beds)
L26861
Somatosensory Testing
L28204
Stress Echocardiography
L28139
Stretta Procedure
L26863
Surgical Decompression for Peripheral Polyneuropathy
L25271
Surgical Treatment of Nails
L26424
Surveillance of Implantable Cardioverter Defibrillators (ICDs), Office, Web or Non-Web Based
L28151
Swallow Evaluation
L28208
Thyrotropin Alfa (Thyrogen)
L28217
Transcatheter Infusion Therapy
L26849
Transesophageal Echocardiography (TEE)
L28162
Transrectal Ultrasound
L26876
Transtelephonic Spirometry
L26874
Transthoracic Echocardiography (TTE)
L28169
Trigger Point Injections
L28186
Troponin Testing
L28173
Unna Boot
L28182
Urinary Incontinence Treatment
L28183
Urodynamics
L26851
Varicose Veins of the Lower Extremity, Treatment of
L25519
Venipuncture Necessitating Physician's Skill for Specimen Collection
L28158
Vertebroplasty and Kyphoplasty (Percutaneous)
L26439
Viral Hepatitis Serology Tests
L28197
Visual Fields Testing
L26367
Vitamin B-12 Injections
L28218
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