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 A Articles Archive @ CMS - New Jersey
  
• Complete Part A LCD Archive @ CMS - New Jersey

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LCD ID	LCD Title		Effective Date	Revision Effective Date	End Date	Last Approval / Revision Date
L1281	Acute Care: Inpatient, Observation and Treatment Room Services		06/01/2002	12/31/2005	N/A	01/02/2008
Procedure Codes: G0378 G0379
L13243	Adenosine (Adenocard)		09/30/2003	12/17/2005	N/A	10/02/2007
Procedure Codes: J0150 J0152
L17635	Alefacept Therapy		09/29/2004	09/29/2004	N/A	10/30/2007
Procedure Codes: J0215
L1290	Anesthesia for Transvenous Pacemaker Insertion		12/27/1996	07/27/2005	N/A	10/02/2007
Procedure Codes: 00530
L23482	Audiology and Vestibular Function Tests		09/30/2006	11/18/2006	N/A	04/03/2008
Procedure Codes: 92541 92542 92543 92544 92545 92546 92547 92552 92553 92555 92556 92557 92561 92562 92563 92564 92565 92568 92569 92571 92572 92575 92576 92577 92579 92582 92583 92584 92585 92586 925877 92588 92596 92597 92620 92621
L1293	Bacterial Culture		10/19/1997	01/29/2005	N/A	09/17/2007
Procedure Codes: 87081 87084 87186 87187
L1348	Barium Swallow (Video/Cine)		10/16/1997	04/20/2006	N/A	10/04/2007
Procedure Codes: 70370 70371 74230
L1303	Bladder Tumor Antigen		07/01/1997	12/08/2005	N/A	10/02/2007
Procedure Codes: 86294
L1306	Blepharoplasty		09/28/2000	12/09/2005	N/A	10/02/2007
Procedure Codes: 15822 15823 67901 67902 67903 67904 67906 67908
L1316	Blood Glucose Testing		02/20/1997	07/23/2005	N/A	03/20/2008
Procedure Codes: 82947 82948 82962
L1343	Bone Density Measurement		01/01/1998	03/07/2008	N/A	03/07/2008
Procedure Codes: 76977 77078 77079 77080 77081 77083 G0130
L1321	Botulinum Toxin Type A		12/27/1996	10/01/2006	N/A	10/02/2007
Procedure Codes: J0585 J3490 34513 31570 31571 46505 64612 64613 64614 64650 67345,92265 95860 95861 95869 95873 95874
L20721	Carboplatin		09/30/2005	04/20/2006	N/A	06/21/2007
Procedure Codes: J9045
L1068	Cardiac Catheterization		03/15/1999	03/11/2008	N/A	03/11/2008
Procedure Codes:
L23480	Cardiac Computed Tomography		09/30/2006	09/30/2006	N/A	04/03/2008
Procedure Codes: 71275 0145T 0146T 0147T 0148T 0149T 0150T 0151T 0144T
L23499	Cardiac Rehabilitation		09/30/2006	03/10/2008	N/A	03/11/2008
Procedure Codes: 93797 93798
L26156	Category III CPT ® Codes		09/30/2007	09/30/2007	N/A	04/03/2008
Procedure Codes:
L1081	Chest X-Ray		06/20/1996	07/20/2005	N/A	03/19/2008
Procedure Codes: 71010 71015 71020 71021 71022 71023 71030 71034 71035
L1116	Colonoscopy		12/27/1996	12/07/2005	N/A	09/10/2007
Procedure Codes: 44388 44389 44390 44391 44392 44393 44394 45355 45378 45379 45380 45382 45383 45384 45385 G0105 G0121
L23478	CT Colonography (Virtual Colonoscopy)		09/30/2006	N/A	N/A	10/30/2007
Procedure Codes: 0067T 0066T
L1130	Diagnostic Mammogram		10/16/1997	02/06/2007	N/A	09/10/2007
Procedure Codes: 77051 77055 77056 G0204 G0206
L13302	Dialysis Frequency		09/30/2003	12/14/2005	N/A	06/27/2007
Procedure Codes: 90999
L1137	Electrocardiogram		04/01/1998	12/08/2005	N/A	03/19/2008
Procedure Codes: 93000 93005 93010
L1241	Electrocardiographic Monitoring for 24 Hours (Holter Monitoring)		07/12/2000	12/09/2005	N/A	03/19/2008
Procedure Codes: 93224 93225 93226 93227 93230 93231 93232 93233 93235 93236 93237
L1139	Electrophysiology Studies (EPS)		12/27/1996	07/27/2005	N/A	01/02/2008
Procedure Codes: 93600 93602 93603 93609 93610 93612 93613 93616 93618 93619 93620 93621 93622 93623 93624 93631 93640 93641 93642 93650
L1938	Epoetin Alfa (Epogen, EPO, Erythropoietin)		09/29/2002	12/09/2005	N/A	09/28/2007
Procedure Codes: J0885 Q4055 J0886 Q0481
L1942	Erythropoietin Analogs (Aranesp, Darbepoetin)		09/29/2002	05/09/2006	N/A	04/03/2008
Procedure Codes: Q01137 Q4054 J0881 J0882
L13281	Extracorporeal Shock-Wave Therapy for Musculoskeletal Problems		09/30/2003	12/17/2005	N/A	10/05/2007
Procedure Codes: 0020T 0019T
L13232	Ferrlecit and Venofer		09/30/2003	12/14/2005	N/A	10/02/2007
Procedure Codes: J1756 J2916
L1140	Flow Cytometry		12/27/1996	12/07/2005	N/A	09/10/2007
Procedure Codes: 88182
L1162	Ground Ambulance Services		06/01/2002	09/17/2007	N/A	12/27/2007
Procedure Codes: A0425 A0426 A0427 A0428 A0429 A0433 A0434 A0888
L1565	HCG - Human chorionic gonadotropin-Tumor Antigen by Immunoassay, Qualitative		07/01/1997	12/08/2005	N/A	10/05/2007
Procedure Codes: 84703
L1641	Hepatitis B (Serologic Testing)		07/22/1995	02/08/2006	N/A	03/20/2008
Procedure Codes: 86704 86706 86707 87340
L1944	Human Skin Equivalent (HSE)		09/29/2002	01/25/2008	N/A	04/03/2008
Procedure Codes: J7340 J7342 15340 15341 15360 15361 15363 15366
L1242	Ifosfamide (Ifex)		02/20/1997	07/27/2005	N/A	03/19/2008
Procedure Codes: J9208
L1243	Impotency Treatment		12/27/1996	08/04/2005	N/A	09/17/2007
Procedure Codes: 54400 54401 54405 54406 54408 54410 54415 54416
L1244	Indocyanine Green Angiography		12/27/1996	12/07/2005	N/A	09/17/2007
Procedure Codes: 92240
L1948	Infliximab		09/29/2002	12/09/2005	N/A	06/21/2007
Procedure Codes: J1745
L1247	Injectable Iron Preparation		12/27/1996	07/19/2005	N/A	03/19/2008
Procedure Codes: J1751 J1752
L1248	Injection, Tendon Sheath, Ligament, Trigger Points or Ganglion Cyst		12/27/1996	08/04/2005	N/A	10/02/2007
Procedure Codes: 20550 20551 20552 20553 20600 20605
L22951	Inpatient Rehabilitation		08/01/2007	N/A	N/A	04/23/2008
Procedure Codes:
L13228	Intensity Modulated Radiation Therapy (IMRT)		09/30/2003	04/25/2006	N/A	03/19/2008
Procedure Codes: 77301 77418 0073T
L1249	Interventional Cardiology		12/27/1996	12/07/2005	N/A	10/02/2007
Procedure Codes: 92980 92981 92984 92995 92996
L1253	Intravenous Immunoglobulin (IVIG)		06/01/2002	01/01/2006	N/A	03/20/2008
Procedure Codes: J1567 Q4087 Q4088 Q8091 Q4092 J1561 J1568 J1569 J1572 J1565 J1566
L1257	Ionized Calcium		02/20/1997	05/10/2005	N/A	03/20/2008
Procedure Codes: 82330
L1951	Kyphoplasty		09/29/2002	12/09/2005	N/A	06/21/2007
Procedure Codes: C9718 C9719 22523 22524 22525
L1264	Laser Assisted Uvulopalatoplasty (LAUP)		11/27/1996	08/04/2005	N/A	10/02/2007
Procedure Codes: 42299
L1266	Leuprolide/Goserelin		10/16/1997	12/07/2005	N/A	10/02/2007
Procedure Codes: J9202 J9217 J9219
L1326	Lumbar Spine MRI		12/27/1996	07/27/2005	N/A	03/20/2008
Procedure Codes: 72148 72149 72158
L1338	Lumbosacral Spine X-Ray		12/27/1996	07/27/2005	N/A	03/20/2008
Procedure Codes: 72100 72110
L1340	Magnesium		02/20/1997	07/27/2005	N/A	09/17/2007
Procedure Codes: 83735
L13225	Mohs Micrographic Surgery (MMS)		09/30/2003	12/09/2005	N/A	10/04/2007
Procedure Codes: 17311 17312 17313 17314 17315
L13239	Neupogen (Filgrastim) and Neulasta (Pegfilgrastim)		09/30/2003	12/14/2005	N/A	05/23/2008
Procedure Codes: J1440 J1441 J2505
L13202	Non-Covered Services		09/30/2003	04/24/2006	N/A	04/03/2008
Procedure Codes: 77605 77620 82016 82017 84525 85337 86316 96343 86378 86602 86628 86723 86732 87272 87470 87471 87472 87475 87476 87477 87487 87492 87511 87512 87525 87526 87527 87529 87530 87532 87533 87540 87541 87542 87552 87557 87562 87580 87581 87582 87592 87620 87621 87622 87650 87652 88371 88372 88371 88372 92548 92970 92971 93720 93721 93722 95806 G0167 G0185 G0187 J3520 80055 80103 82016 82017 82172 82286 82485 82489 82664 83634 83883 84061 84255 84525 84830 85337 86243 86316 86343 86378 86602 86628 86723 86273 86970 86971 86972 86975 86976 86977 86978 87272 87470 87471 87472 87475 87476 87477 87485 87487 87492 87511 87512 87525 87526 87527 87529 87530 87531 87532 87533 87540 87541 87542 87552 87557 87562 87580 87581 87582 87592 87620 87621 87622 87650 87652 88000 88005 88007 88012 88014 88016 88020 88025 88027 88028 88029 88036 88037 88040 88045 88099 88371 88372 89250 89251 89254 89255 89257 89258 89259 89260 89261 89264 P2028 P2029 P2033 P2038 90476 90477 90581 90585 90632 90633 90634 90645 90646 90647 90648 90660 90665 90680 90690 90691 90692 90693 J0275 J1056 J3520 J3530 01990 11975 11977 11980 15820 15821 15824 15825 15826 25828 15829 15876 15877 15878 15879 17380 58321 58322 58323 58670 58671 58970 58974 58976 59012 77605 77620 92548 92970 92971 92997 92998 93720 93721 93722 93740 94014 94015 94016 95806 95831 95832 95833 95851 95852 97545 97546 99185 99186 99360 D9248 15775 15776 32491 55970-55980 56805,57335 65760 65767 65771 75159 72198 73225 76390 78351 78608 78609 78810 82435 90875 90876 93760 93762 96902 97014 97780 97781 98943 99391-99397 A4260 A4261 G0192 G0219 J3420 J3570 M0075,M0076 M0100 M0300 M0301 P9019 P9033 Q2001 80050 82435 86910 86911 P2031 A4261 J3420 J3570 P9019 P9033 35475 56805 57335 72159 72198 73225 76140 76390 78351 78608 78609
L1352	Noninvasive Vascular Studies		12/27/1996	12/07/2005	N/A	03/20/2008
Procedure Codes: 76936 93875 93880 93882 93886 93888 93922 93923 93924 93925 93926 93930 93931 93965 93970 93971 93975 93976 93978 93979 93980 93981 93990
L1363	Occult Blood, Feces Testing		10/16/1997	04/13/2007	N/A	01/02/2008
Procedure Codes: 82270 82272 82274 G0328
L17637	Occupational Therapy		09/30/2005	09/11/2006	N/A	11/10/2007
Procedure Codes: 29065 29075 29085 29105 29125 29126 29130 29131 29220 29240 29260 29280 29345 29355 29365 29405 29425. 29445 29505 29515 97003 97004 97010 97016 97018 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039 97110 97112 97113 97124 97139 97140 97150 97530 97532 97533 97535 97537 97542 97750 97755 97760 97761 97762 G0281 G0282 G0283 64550 90901 90911 95831 95832 95833 95834 95851 95852
L13121	Off-Label Coverage of FDA Approved Drugs and Biologicals		09/30/2003	01/01/2007	N/A	05/14/2008
Procedure Codes:
L17632	Oxaliplatin for Injection (Eloxatin)		07/15/2003	11/24/2004	N/A	03/19/2008
Procedure Codes: J9263
L1379	Partial Hospitalization		07/19/1995	07/27/2005	N/A	11/29/2007
Procedure Codes: 90801 90802 90816 90817 90818 90821 90823 90826 90827 90828 90846 90847 90849 90853 90857 90899 97532 G0129 G0176 G0177
L1406	Patient Education		01/25/1995	07/26/2005	N/A	03/20/2008
Procedure Codes:
L1412	Pelvic Echography for Prostate Follow-up		12/27/1996	08/04/2005	N/A	10/05/2007
Procedure Codes: 76856 76857
L1413	Percutaneous Transluminal Angioplasty in Renal Disease		12/27/1996	12/07/2005	N/A	05/24/2007
Procedure Codes: 35471 75966 76499
L1959	Percutaneous Vertebroplasty		09/29/2002	12/09/2005	N/A	06/21/2007
Procedure Codes: 22520 22521 22522
L17639	Physical Medicine and Rehabilitation Modalities		09/30/2004	05/10/2007	N/A	06/22/2007
Procedure Codes: 97010 97018 97022 97026 97028 97034 97024 97032 97033 97035 97124 G0283 90901 90911 97012 97016 97036
L1642	Potassium (Serum)		12/27/1996	07/28/2005	N/A	03/20/2008
Procedure Codes: 84132
L1426	PRN Orders for Skilled Nursing Facilities		04/01/1998	12/08/2005	N/A	10/05/2007
Procedure Codes:
L1428	Prostatic Acid Phosphatase (PAP)		10/16/1997	12/08/2005	N/A	10/05/2007
Procedure Codes: 84066
L13725	Psychiatric Inpatient Hospitalization		12/06/2003	12/15/2005	N/A	09/28/2007
Procedure Codes:
L1372	Psychiatric Services-Outpatient Hospital based		09/28/2000	12/09/2005	N/A	01/02/2008
Procedure Codes:
L1593	Psychiatry and Psychology Services		12/27/1996	01/01/2006	N/A	01/02/2008
Procedure Codes: 90801 90802 90804 90805 908806 90807 90808 90809 90810 90815 90823 90829 90845 90846 90847 90849 90853 90857 90862 90865 90870 90880 90882 90889 90899 96101 96102 96103 96105 96110 96111 96116 96118 96119 96120
L1594	Pulmonary Perfusion Imaging		12/27/1996	08/06/2005	N/A	09/27/2007
Procedure Codes: 78580 78584
L1605	Pulmonary Rehabilitation		05/20/2002	12/31/2005	N/A	01/09/2007
Procedure Codes: M0064 94799 G0237 G0238 G0239
L1597	Removal Impacted Cerumen		12/27/1996	07/28/2005	N/A	10/30/2007
Procedure Codes: 69210
L1865	Removal of Benign Skin Lesions		12/27/1996	03/31/2004	N/A	01/02/2008
Procedure Codes: 11055 11056 11057 11300 11301 11302 11303 11305 11306 11307 11308 11310 11311 11312 11313 11400 11401 11402 11403 11404 11420 11421 11422 11423 11424 11426 11440 11441 11442 11443 11444 11446 17000 17003 17004 17110 17340
L13295	Renal and Iliac Angiography and Aortography		09/30/2003	12/14/2005	N/A	01/02/2008
Procedure Codes: 36200 36245 75600 75605 75625 75630 75635 75722 75724 75736 G0275 G0278
L1626	Respiratory Therapy		05/15/1998	05/24/2007	N/A	03/20/2008
Procedure Codes: 31500 31502 94002 94003 94004 94010 94060 94070 94150 94200 94640 94642 94660 94662 94664 94667 94668 94760 94761 94762 94772
L17645	Resynchronization for Congestive Heart Failure		07/15/2002	11/18/2006	N/A	06/28/2007
Procedure Codes: 33208 33214 33215 33224 33225 33226 33241 33243 33244 33249
L1628	Rheumatoid Factor Test		10/16/1997	12/08/2005	N/A	10/30/2007
Procedure Codes: 86430 86431
L4874	Rural Health Clinic		12/27/2002	11/16/2007	N/A	11/16/2007
Procedure Codes:
L1664	Steroid Injections		12/27/1996	07/27/2005	N/A	04/03/2008
Procedure Codes: J1100
L1669	Syphilis Test		10/16/1997	12/08/2005	N/A	10/30/2007
Procedure Codes: 86592 86593 86781
L1676	Transrectal Echography for Prostatic Disease		12/27/1996	11/07/2004	N/A	10/30/2007
Procedure Codes: 76872 55700 76942
L1682	Transthoracic Echocardiography (TTE)		12/27/1996	03/10/2008	N/A	05/14/2008
Procedure Codes: 93307 93308 93320 93321 93325 C8923 C8924
L1686	Troponin		09/28/2000	12/09/2005	N/A	10/30/2007
Procedure Codes: 84484 84512
L1567	Urinalysis		05/15/1998	12/08/2005	N/A	03/20/2008
Procedure Codes: 81000 81001 81002 81003 81005 81007 81015
L23488	Viscosupplementation Therapy		09/30/2006	01/29/2008	N/A	01/29/2008
Procedure Codes: Q4083 Q4084 Q4085 Q4086 J3490 J7321 J7322 J7323 J7324 20610
L17673	Vision Rehabilitation for Low Vision Patients		09/30/2004	11/07/2004	N/A	01/02/2008
Procedure Codes: 97001 97002 97003 97004 97530 97532 97533 97535 97537
L1831	Wireless Capsule Endoscopy		09/29/2002	12/09/2005	N/A	10/30/2007
Procedure Codes: 91110
L13570	Wound Care		12/06/2003	12/15/2005	N/A	11/16/2007
Procedure Codes: 97597 97598 97602 G0281 11000 11001 11004 11005 11006 11008 11010 11011 11012 11040 11041 11042 11043 11044 97001 97002 97003 97014 97022 97026 97028 97032 97039 97139 97799 99183 99211 C1300 G0128 G0168 G0282 G0295