Medicare Administrative Contractor (MAC)
| Local Coverage Determinations (LCD) and Policy Articles
|
CGS Administrators, LLC (CGS)
| - L34045 Non-Invasive Vascular Studies, Revision Effective Date 06/12/2025 [1]
- A56697 Billing and Coding: Non-Invasive Vascular Studies, Revision Effective Date 03/23/2025 [2]
- L34049 Outpatient Physical and Occupational Therapy Services, Revision Effective Date 05/29/2025 [3]
- A57067 Billing and Coding: Outpatient Physical and Occupational Therapy Services, Revision Effective Date 05/29/2025 [4]
- L36690 Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities, Revision Effective Date 09/05/2024 [5]
- A56696 Billing and Coding: Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities, Revision Effective Date 09/05/2024 [6]
- A55276 Response to Comments: Wound Application of Cellular and/or Tissue Based products (CTPs), Lower Extremities, Original Effective Date 10/10/2016 [7]
- L34032 Debridement Services, Revision Effective Date 10/03/2024 [8]
- A56459 Billing and Coding for Debridement Services, Revision Effective Date 10/03/2024 [9]
- L33942 Physical Therapy - Home Health, Revision Effective Date 06/27/2024 [10]
- A57311 Billing and Coding: Physical Therapy - Home Health, Revision Effective Date 06/27/2024 [11]
- L33830 Pressure Reducing Support Surfaces - Group 1, Revision Effective Date 05/01/2021 [12]
- A52489 Pressure Reducing Support Surfaces - Group 1 - Policy Article, Revision Effective Date 05/01/2021 [13]
- L33642 Pressure Reducing Support Surfaces - Group 2, Revision Effective Date 05/01/2021 [14]
- A52490 Pressure Reducing Support Surfaces - Group 2 - Policy Article, Revision Effective Date 01/01/2020 [15]
- L33692 Pressure Reducing Support Surfaces - Group 3, Revision Effective Date 05/01/2021 [16]
- A52468 Local Coverage Article: Pressure Reducing Support Surfaces - Group 3 - Policy Article, Revision Effective Date 01/01/2020 [17]
- A59219 Response to Comments: Pneumatic Compression Devices - DL33829, Original Effective Date 09/07/2023 [18]
- L33821 Negative Pressure Wound Therapy Pumps, Revision Effective Date 01/01/2024 [19]
- A52511 Negative Pressure Wound Therapy Pumps - Policy Article, Revision Effective Date 08/15/2021 [20]
- L33831 Local Coverage Determination for Surgical Dressings, Revision Effective Date 01/01/2024 [21]
- A54563 Surgical Dressings - Policy Article, Revision Effective Date 12/05/2024 [22]
- A56175 Low frequency, non-contact, non-thermal ultrasound (CPT code 97610), Revision Effective Date 02/27/2025 [23]
- A55426 Standard Documentation Requirements for All Claims Submitted to DME MACs, Revision Effective Date 01/01/2024 [24]
- L34246 Routine Foot Care and Debridement of Nails, Revision Effective Date 08/08/2024 [74]
- L39756 Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [25]
- A59618 Billing and Coding: Skin Substitutes Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Revision Effective Date 01/01/2026 [26]
- A59941 Response to Comments: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [27]
|
First Coast Service Options, Inc. (FCSO)
| - L37166 Wound Care, Revision Effective Date 07/23/2020 [28]
- A55818 Billing and Coding: Wound Care, Revision Effective Date 01/01/2025 [29]
- A55757 Wound care (L37166): Medicare Part A/B local coverage determination (LCD) comment summary, Revision Effective Date 12/07/2017 [30]
- L33667 Duplex Scan Of Lower Extremity Arteries, Revision Effective Date 10/01/2019 [31]
- L33693 Non-Invasive Evaluation of Extremity Veins, updated on 01/28/2024, Revision Effective Date 01/28/2024 [32]
- L33696 Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries [33] - RETIRED
- A58810 Billing and Coding: Platelet Rich Plasma, updated on 07/01/2023, Revision Effective Date 07/01/2023 [76]
- L36377 Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities, Revision Ending Date 12/31/2025 [34]
- A57680 Billing and Coding: Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities, Revision Effective Date 08/13/2020 [35]
- L36377 Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Revision Effective Date 01/01/26 [36]
- A57680 Billing and Coding: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Revision Effective Date 01/01/26 [37]
- L38720 Local Coverage Determination (LCD) Treatment of Chronic Venous Insufficiency of the Lower Extremities, Original Effective Date 12/27/2020 [38]
- L39071 Platelet Rich Plasma, Revision Effective Date 12/12/2021 [77]
- A59518 Response to Comments: Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 08/03/2023 [39]
- A59824 Response to Comments: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [40]
|
National Government Services, Inc. (NGS)
| - L33563 Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures, Revision Effective Date 09/12/2019 [41]
- L33614 Debridement Services, Revision Effective Date 11/07/2019 [42]
- A56617 Billing and Coding: Debridement Services, Revision Effective Date 01/01/2024 [43]
- L33627 Non-Invasive Vascular Studies, Revision Effective Date 10/01/2019 [44]
- L33631 Outpatient Physical and Occupational Therapy Services, Revision Effective Date 01/01/2020 [45]
- A56566 Billing and Coding: Outpatient Physical and Occupational Therapy Services, Revision Effective Date 01/01/2025 [46]
- A57759 Billing and Coding: Routine Foot Care and Debridement of Nail, Revision Effective Date 08/22/2024 [47]
- L38937 Platelet Rich Plasma, Revision Effective Date 02/10/2022 [78]
- L39828 Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [48]
- A59953 Response to Comments: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [49]
- A59712 Billing and Coding: Skin Substitutes Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [50]
|
Noridian
| - A53046 Wound Care and Debridement - Provided by a Therapist, Physician, NPP, or as Incident-to Service, Revision Effective Date 01/01/2024 [51]
- A53296 Wound Care & Debridement – Provided by a Therapist, Physician, NPP or as Incident-to Services, Revision Effective Date on 01/01/2024 [52]
- A52959 Billing and Coding: Lymphedema Decongestive Treatment, Revision Effective Date 01/01/2018 [53]
- A55710 Lymphedema Decongestive Treatment, Revision Effective Date 01/01/2018 [54]
- A52918 Coverage of Foot Care Services, Revision Effective Date 10/01/2015 [55]
- L33821 Negative Pressure Wound Therapy Pumps, Revision Effective Date 01/01/2024 [ [19]
- A52511 Negative Pressure Wound Therapy Pumps - Policy Article, Revision Effective Date 08/15/2021 [20]
- L33830 Pressure Reducing Support Surfaces - Group 1, Revision Effective Date 05/01/2021 [12]
- A52489 Pressure Reducing Support Surfaces - Group 1 - Policy Article, Revision Effective Date 05/01/2021 [13]
- L33642 Pressure Reducing Support Surfaces - Group 2, Revision Effective Date 05/01/2021 [14]
- A52490 Pressure Reducing Support Surfaces - Group 2 - Policy Article, Revision Effective Date 01/01/2020 [15]
- L33692 Pressure Reducing Support Surfaces - Group 3, Revision Effective Date 05/01/2021 [16]
- A52468 Pressure Reducing Support Surfaces - Group 3 - Policy Article, Revision Effective Date 01/01/2020 [17]
- L33831 Local Coverage Determination for Surgical Dressings, Revision Effective Date 01/01/2024 [21]
- A59219 Response to Comments: Pneumatic Compression Devices - DL33829, Original Effective Date 09/07/2023 [18]
- A54710 Response to Comments: Treatment of Varicose Veins of Lower Extremities, Original Effective Date 03/12/2016 [56]
- A54713 Response to Comments: Treatment of Varicose Veins of Lower Extremities, Original Effective Date 03/12/2016 [57]
- A54714 Response to Comments: Treatment of Varicose Veins of Lower Extremities, Original Effective Date 03/12/2016 [58]
- A54715 Response to Comments: Treatment of Varicose Veins of Lower Extremities, Original Effective Date 03/12/2016 [59]
- A54563 Surgical Dressings - Policy Article, Revision Effective Date 12/05/2024 [22]
- A58565 Billing and Coding: Wound and Ulcer Care, Revision Effective Date 01/01/2025 [79]
- A58567 Billing and Coding: Wound and Ulcer Care, Revision Effective Date 01/01/2025 [80]
- A58903 Response to Comments: Wound and Ulcer Care, Original Effective Date 11/28/2021 [81]
- A58904 Response to Comments: Wound and Ulcer Care, Original Effective Date 11/28/2021 [82]
- L38902 Wound and Ulcer Care, Revision Effective Date 11/28/2021 [83]
- L38904 Wound and Ulcer Care, Revision Effective Date 11/28/2021 [84]
- A57957 Billing and Coding: Routine Foot Care, Revision Effective Date 01/01/2024 [88]
- L35163 Plastic Surgery, Revision Effective Date 02/14/2025 [89]
- A55932 Billing and Coding: JW and JZ Modifier Billing Guidelines, Revision Effective Date 03/21/2024 [60]
- A53024 Billing and Coding: JW and JZ Modifier Billing Guidelines, Revision Effective Date 03/21/2024 [61]
- L39764 Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [62]
- L39760 Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [63]
- A59626 Billing and Coding: Skin Substitutes Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [64]
- A59628 Billing and Coding: Skin Substitutes Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [65]
- A59952 Response to Comments: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [66]
- A59950 Response to Comments: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [67]
|
Novitas Solutions, Inc.
| - L35125 Wound Care, Revision Effective Date 07/23/2020 [68]
- A53001 Billing and Coding: Wound Care, Revision Effective Date 01/01/2025 [69]
- L35041 Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds, Revision Effective Date 09/26/2019 [70]
- A54117 Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds, Revision Effective Date 08/13/2020 [71]
- L35041 Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, future effective on 01/01/26 need new reference linking to future effective [72]
- A54117 Billing and Coding: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Revision Effective Date 01/01/26 [73]
- A59517 Response to Comments: Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 08/03/2023.[74]
- A59823 Response to Comments: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [75]
- A58808 Billing and Coding: Platelet Rich Plasma, Revision Effective Date 07/01/2023 [90]
- L39068 Platelet Rich Plasma, Revision Effective Date 12/12/2021 [92]
- L34924 Local Coverage Determination (LCD) Treatment of Chronic Venous Insufficiency of the Lower Extremities, Revision Effective Date 12/27/2020 [76]
- L34938 Removal of Benign Skin Lesions, Revision Effective Date 09/26/2019 [93]
- L34887 Surgical Treatment of Nails, Revision Effective Date 01/30/2022 [94]
|
Palmetto | - L34428 Outpatient Physical Therapy, Revision Effective Date 05/18/2023 [77]
- L34427 Outpatient Occupational Therapy, Revision Effective Date 04/13/2023 [78]
- A53057 Billing and Coding: Home Health Occupational Therapy, Revision Effective Date 1/1/2025 [79]
- A56731 Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathy, Revision Effective Date 01/01/2024 [80]
- A53065 Billing and Coding: Outpatient Physical Therapy, Revision Effective Date 01/01/2025 [81]
- A53781 Billing and Coding: Spiracur SNaP® Wound Care System, Revision Effective Date 01/01/2024 [82]
- A54555 Billing and Coding: Low frequency, non-contact, non-thermal ultrasound (CPT code 97610), Revision Effective Date 01/01/2024 [83]
- A53064 Billing and Coding: Outpatient Occupational Therapy, Revision Effective Date 1/1/2025 [84]
- A53773 Low frequency, non-contact, non-thermal ultrasound (CPT code 97610), Revision Effective Date 01/01/2024 [85]
- A53058 Billing and Coding: Home Health Physical Therapy, Revision Effective Date 01/01/2025 [95]
- L34560 Home Health Occupational Therapy, Revision Effective Date 06/09/2022 [96]
- A56392 Response to Comments: Topical Oxygen Therapy, Original Effective Date 03/21/2019 [98]
- L37873 Topical Oxygen Therapy, Revision Effective Date 05/04/2023 [99]
- L39121 Local Coverage Determination (LCD): Treatment of Varicose Veins of the Lower Extremities, Revision Effective Date 11/16/2023 [86]
- A59001 Response to Comments: Treatment of Varicose Veins of the Lower Extremities, Original Effective Date 02/17/2022 [87]
- A59281 Response to Comments: Near-Infrared Spectroscopy in Wound and Flap Management, Original Effective Date12/29/2022 [88]
- A59945 Response to Comments: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [89]
- L39806 Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [90]
- A59691 Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Original Effective Date 01/01/2026 [91]
|
Wisconsin Physicians Service Insurance Corporation (WPS)
| - L37228 Wound Care, Revision Effective Date 03/27/2025 [92]
- A55910 Response to Comments: Wound Care (DL37228), Original Effective Date 04/16/2018 [93]
- A55909 Billing and Coding: Wound Care, Revision Effective Date 06/26/2025 [94]
- L35761 Non-Invasive Peripheral Arterial Vascular Studies, Revision Effective Date 10/26/2023 [95]
- A57593 Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies, Revision Effective Date 10/1/2023 [96]
- A57846 Response to Comments: DL37228 Wound Care, Original Effective Date 02/09/2020 [100]
- A56232 Billing and Coding: Foot Care, Revision Effective Date 10/01/2024 [97]
- L39865 Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Revision Effective Date 01/01/2026 [98]
- A59740 Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers, Revision Effective Date 01/01/2026 [99]
- A59954 Response to Comments: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers DL39865, Revision Effective Date 01/01/2026 [100]
|