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.
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.
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 |