The following Local Coverage Determinations were active at the time of the MAC J12 transition. For retired documents or billng & coding articles, please consult these locations:

• Medicare Coverage Database Search @ CMS
  
  
• Complete Part B Articles Archive @ CMS - Maryland | Washington DC | Delaware
  
  
• Complete Part B LCD Archive @ CMS - Maryland | Washington DC | Delaware

Note: All links accessed on this page open in a new browser window, as you will be leaving the Highmark Medicare Services website to view them.

LCD ID	LCD Title		Effective Date	Revision Effective Date	End Date	Last Approval / Revision Date
L24935 L24937 L24939	3D Interpretation and Reporting of Imaging Studies - X-45B		05/17/2007	05/17/2007	N/A	01/25/2008
L17423 L17425 L17427	Allergen Immunotherapy H-11B-R4		09/13/2004	10/01/2006	N/A	11/06/2007
L17413 L17415 L17417	Allergy Skin Testing - H-10B-R4		09/13/2004	02/06/2008	N/A	02/01/2008
L14295 L14296 L14297	Ambulance Services (Ground Ambulance) - T-1B-R19		12/29/2003	04/15/2008	N/A	05/05/2008
L17380 L17382 L17384	Assays for Vitamins and Metabolic Function - L-95B-R10		09/13/2004	07/26/2007	N/A	11/10/2007
L5444 L5182 L5534	Balloon Assisted Percutaneous Vertebroplasty - S - 85B-R3		12/16/2001	01/01/2007	N/A	11/07/2007
L23961 L23963 L23965	Bariatric Surgical Management of Morbid Obesity - S-131B-R3		05/17/2007	11/16/2007	N/A	11/12/2007
L19382 L19380 L19377	Barium Swallow Studies, Modified - F-56B-R5		08/15/2005	10/19/2007	N/A	11/07/2007
L5446 L5158 L5536	Biofeedback for the Treatment of Urinary Incontinence - M -20B-R3		03/25/2002	10/26/2007	N/A	11/07/2007
L17458 L17474 L17476	Blepharoplasty - O - 47B-R1		09/13/2004	09/13/2004	N/A	11/07/2007
L16995 L16997 L17000	Bone Mass Measurement (BMM) - X-37B - R7		01/05/2005	06/19/2007	N/A	11/07/2007
L5450 L5139 L5540	Botulinum Toxin Type A (Botox®)- I-48B-R7		12/16/2001	08/08/2007	N/A	11/07/2007
L14204 L14205 L14206	Cardiac Catheterization - C-37B-R10		12/29/2003	10/01/2007	N/A	11/07/2007
L17012 L17014 L17016	Cardiac Event Detection Monitoring - C-44B-R5		01/05/2005	10/08/2007	N/A	11/07/2007
L5455 L5117 L5545	Cardiac Output Monitoring by Electrical Bioimpedance- F-40B-R7		08/09/2001	05/02/2007	N/A	11/07/2007
L23947 L23949 L23955	Cardiac Rehabilitation C-46B-R1		05/17/2007	01/07/2008	N/A	01/08/2008
L12417 L12418 L12420	Cardiac Rhythm Device Evaluation - C-35B-R6		04/28/2003	10/01/2007	N/A	11/07/2007
L18391 L18393 L18395	Cardiovascular Nuclear Medicine - C-45B-R3		04/21/2005	10/15/2007	N/A	11/10/2007
L17024 L17028 L17030	Cardiovascular Stress Testing-C-43B-R3		01/05/2005	10/08/2007	N/A	11/07/2007
L18507 L18509 L18511	Cataract Extraction (including Complex Cataract Surgery) – S-124B-R3		04/21/2005	10/05/2007	N/A	11/07/2007
L12425 L12426 L12427	Chelation Therapy - I-63B-R4		04/28/2003	08/09/2007	N/A	11/07/2007
L18435 L18437 L18439	Chiropractic Services - N-5B-R2		04/21/2005	04/21/2005	N/A	11/07/2007
L18407 L18409 L18411	Colony Stimulating Factors - I-74B-R3		04/21/2005	08/17/2007	N/A	11/07/2007
L18455 L18463 L18467	Complex Decongestive Physiotherapy (CDP) for Lymphedema – Y-17B-R6		04/21/2005	06/01/2007	N/A	11/07/2007
L21223 L21225 L21227	Computed Tomographic Arteriography (CTA) of the Chest – X-43B-R4		05/08/2006	11/13/2007	N/A	11/12/2007
L24004 L24006 L24008	Computerized Axial Tomography (CT), Thorax X-46B-R1		05/17/2007	10/08/2007	N/A	11/07/2007
L5461 L5310 L5551	Continuous Glucose Monitoring- M-21B-R3		08/12/2002	04/03/2006	N/A	11/07/2007
L24578 L24580 L24582	Cryosurgical and Radiofrequency Ablation of Hepatic Tumors-S-132B		08/25/2007	08/25/2007	N/A	11/07/2007
L18515 L18517 L18519	Diagnostic and Therapeutic Esophagogastro-duodenoscopy (EGD) - S -125B-R4		04/21/2005	08/01/2007	N/A	11/08/2007
L5468 L5220 L5558	Diagnostic Mammography - F -42B-R10		12/16/2001	04/01/2007	N/A	11/08/2007
L14252 L14253 L14254	Drugs and Biologicals - Chemotherapeutic Drugs - J9000-J9999 - I-68B-R38		12/29/2003	02/28/2008	N/A	05/02/2008
L13360 L13361 L13362	Drugs and Biologicals, Non-Chemotherapeutic - I -66B-R33		08/21/2003	04/23/2008	N/A	05/02/2008
L16445 L16444 L16443	Echocardiography C-38B-R8		05/10/2004	11/16/2007	N/A	11/12/2007
L17403 L17405 L17407	Electrocardiography C-40B-R5		09/13/2004	10/16/2007	N/A	11/08/2007
L7798 L12176 L12177	Electrodiagnostic Studies (NCS/EMG) - F-53B-R15		12/16/2002	05/09/2008	N/A	05/15/2008
L17526 L17528 L17530	Flow Cytometry - L - 93B-R3		09/13/2004	10/19/2007	N/A	11/08/2007
L14228 L14229 L14230	Frequency for Laboratory Tests - L - 98B-R7		05/08/2006	01/11/2008	N/A	01/08/2008
L20272 L20276 L20278	Fundus Photography - O-52B-R1		01/01/2006	10/01/2006	N/A	11/08/2007
L22985 L22987 L22989	Gastrointestinal Tract Diagnostic Evaluation - F- 60B -R3		01/01/2007	08/03/2007	N/A	11/08/2007
L17188 L17190 L17192	General and Extended Ophthalmologic Services - O -48B - R3		01/05/2005	10/08/2007	N/A	11/09/2007
L18443 L18445 L18447	Gonioscopy - O - 50B - R2		04/21/2005	10/19/2007	N/A	11/08/2007
L12407 L12408 L12409	Holter Monitoring - C-34B-R4		04/28/2003	10/03/2007	N/A	11/08/2007
L21600 L21602 L21604	Hyaluronate Polymers - I-73B-R7		01/01/2006	11/30/2007	N/A	12/19/2007
L5485 L5202 L5575	Hyperbaric Oxygen (HBO) Therapy - M-15B-R5		12/16/2001	10/01/2004	N/A	11/08/2007
L18483 L18485 L18487	Imaging of the Head, Neck and Brain: MRI and CT - X-40B-R5		04/21/2005	10/05/2007	N/A	11/08/2007
L17102 L17104 L17106	Imaging of the Spine: MRI and CT-X-39B-R7		01/05/2005	10/16/2007	N/A	11/08/2007
L22971 L22973 L22975	Immunizations - I-80B-R6		01/01/2007	05/20/2008	N/A	05/16/2008
L13350 L13351 L13352	Implantable Infusion Pump - M-24B-R12		08/21/2003	10/05/2007	N/A	11/10/2007
L17494 L17496 L17498	Infectious Disease Molecular Diagnostic Testing - L -91B-R10		09/13/2004	11/27/2007	N/A	11/26/2007
L17433 L17435 L17437	Infliximab I-70B-R7		09/13/2004	11/02/2007	N/A	11/08/2007
L20270 L20274 L20280	Intensity Modulated Radiation Therapy (IMRT) - R-17B-R6		01/01/2006	10/17/2007	N/A	11/08/2007
L17128 L17131 L17133	Interventional Cardiology - C -42B-R3		01/05/2005	10/08/2007	N/A	11/08/2007
L17141 L17143 L17145	Intraoperative Neurophysiological Monitoring - F-55B-R4		01/05/2005	01/01/2008	N/A	01/02/2008
L17353 L17357 L17359	Intravenous Immune Globulin (IVIG) – I-71B-R16		09/13/2004	04/22/2008	N/A	05/05/2008
L18451 L18453 L18457	Lacrimal Punctum Closure – O-51B-R1		04/21/2005	04/21/2005	N/A	11/08/2007
L14174 L14175 L14176	Laser (Optical) Coherence Tomography - O-45B-R7		12/29/2003	11/27/2007	N/A	11/27/2007
L18415 L18417 L18419	Leucovorin Calcium (Citrovorum Factor™) I - 75B-R3		04/21/2005	09/07/2007	N/A	11/09/2007
L20317 L20319 L20325	Luteinizing Hormone-Releasing Hormone (LHRH) Analogs I-79B-R7		01/01/2006	12/04/2007	N/A	01/03/2008
L5499 L5427 L5589	Mohs' Micrographic Surgery (MMS) - S - 102B-R4		08/12/2002	01/01/2007	N/A	11/09/2007
L16433 L16432 L16431	Monitored Anesthesia Care (MAC) - A-11B-R12		05/10/2004	11/30/2007	N/A	12/19/2007
L17159 L17161 L17163	MRI of a Joint - X-38B-R8		01/05/2005	10/05/2007	N/A	11/09/2007
L14161 L14162 L14163	Nail Avulsion - P-6B-R1		12/29/2003	10/28/2005	N/A	11/10/2007
L13344 L13345 L13347	Non-covered Services - Z-14B-R37		08/21/2003	02/22/2008	N/A	02/27/2008
L18531 L18533 L18535	Non-Invasive Cerebrovascular Studies - U -16B-R4		04/21/2005	01/30/2007	N/A	11/09/2007
L18499 L18501 L18503	Non-Invasive Peripheral Arterial Studies - U-17B-R5		04/21/2005	10/19/2007	N/A	11/09/2007
L18491 L18493 L18495	Non-Invasive Venous Studies - U-18B-R6		04/21/2005	10/19/2007	N/A	11/09/2007
L17174 L17176 L17178	Ophthalmic A and B Scans - O-49B-R1		01/05/2005	04/03/2006	N/A	11/09/2007
L12489 L12490 L12491	Oral Maxillofacial Prosthesis - Q-22B -R5		04/28/2003	10/17/2007	N/A	11/09/2007
L20292 L22172 L20296	Outpatient Physical Medicine and Rehabilitation - Y-18B-R13		01/01/2006	04/18/2008	N/A	05/05/2008
L17446 L17448 L17450	Pain Management - M - 27B-R4		09/13/2004	01/01/2007	N/A	11/09/2007
L16786 L16787 L16788	Paravertebral Facet Joint Denervation - S-118B-R5		12/29/2003	09/01/2006	N/A	11/09/2007
L17200 L17202 L17204	Percutaneous Vertebroplasty - Y-16B-R2		01/05/2005	01/01/2007	N/A	11/09/2007
L12454 L12455 L12456	Photodynamic Therapy with Verteporfin (Visudyne®) - O -43B-R7		04/28/2003	01/28/2008	N/A	01/31/2008
L21302 L21304 L21306	Positron Emission Tomography - X - 42B-R9		05/08/2006	03/17/2008	N/A	03/17/2008
L14221 L14222 L14223	Psychiatric Codes - V-15B-R13		12/29/2003	03/07/2008	N/A	03/19/2008
L7711 L7807 L7808	Pulmonary Function Testing- F-51B-R9		12/16/2002	10/05/2007	N/A	11/10/2007
L7800 L7803 L7806	Pulmonary Stress Testing- F-52B-R6		12/16/2002	10/05/2007	N/A	11/09/2007
L17392 L17394 L17396	Removal of Benign and Malignant Skin Lesions - S-121B-R2		09/13/2004	01/01/2007	N/A	11/10/2007
L17212 L17214 L17216	Respiratory Therapy and Oximetry Services - Y-15B-R8		01/05/2005	10/05/2007	N/A	11/09/2007
L5515 L4916 L5605	Risk Stratification for Ventricular Arrhythmia Using T-Wave Alternans Testing - C-29B-R5		03/25/2002	09/18/2007	N/A	11/09/2007
L12477 L12478 L12479	Routine Foot Care/Mycotic Nail Debridement - P-5B-R9		04/28/2003	02/22/2008	N/A	02/28/2008
L23039 L23041 L23043	Skin Substitutes/ Replacements S - 129B-R8		01/01/2007	03/14/2008	N/A	03/21/2008
L21286 L21288 L21290	Sleep Studies and Overnight Oximetry - F-59B-R5		05/08/2006	10/05/2007	N/A	11/10/2007
L21263 L21265 L21267	Special Electroencepha-lography - F -58B-R2		05/08/2006	05/08/2006	N/A	11/10/2007
L22998 L23000 L23002	Spinal Cord Stimulation (Dorsal Column Stimulation) -S-128B-R3		01/01/2007	10/26/2007	N/A	11/10/2007
L5522 L4893 L5612	Synthetic Erythropoietin Substitutes - I - 50B-R23		03/25/2002	02/15/2008	N/A	02/19/2008
L5525 L4878 L5615	Thermotherapies (Minimally Invasive Surgical Techniques (MISTs) for Benign Prostatic Hyperplasia (BPH))- S - 86B-R4		12/01/2001	01/01/2005	N/A	11/10/2007
L18423 L18425 L18427	Thrombolytic Agents - I - 76B-R5		04/21/2005	08/23/2007	N/A	11/10/2007
L19405 L19403 L19393	Treatment of Varicose Veins of the Lower Extremities - S-126B-R3		08/15/2005	11/30/2007	N/A	11/28/2007
L18523 L18525 L18527	Ultrasound Examinations: Abdominal and Retroperitoneal - U - 15B-R10		04/21/2005	10/19/2007	N/A	11/10/2007
L22144 L22146 L22148	Vagus Nerve Stimulation (VNS) - S-127B-R3		08/16/2006	07/23/2007	N/A	11/10/2007
L13365 L13366 L13367	Vascular Access for Hemodialysis - S-116B-R16		08/21/2003	01/24/2008	N/A	01/25/2008
L21199 L21201 L21203	Vertebral Fracture Assessment (VFA) - X-41B-R2		05/08/2006	01/01/2007	N/A	11/10/2007
L21249 L21251 L21253	Vestibular and Audiologic Function Tests - F-57B-R8		05/08/2006	04/28/2008	N/A	05/06/2008
L16437 L16436 L16435	Visual Field Examination and Visual Field Examination for Glaucoma O-46B-R5		05/10/2004	10/01/2006	N/A	11/10/2007
L18475 L18477 L18479	Vitrectomy in Conjunction with Cataract Surgery - S - 123B-R2		04/21/2005	11/27/2007	N/A	11/20/2007
L23992 L23994 L23996	Wound Care – Chronic Refractory Wounds - S-130B-R3		05/17/2007	01/29/2008	N/A	01/29/2008
L17482 L17484 L17486	YAG Capsulotomy S - 120B- R3		09/13/2004	11/27/2007	N/A	11/20/2007