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Current Active NH/VT LCD
CV-I-002-R12 - Cardiac Rehabilitation
CV-I-0004-R9 - Holter Monitors - Long Term ECG/EKG Monitoring
CV-I-0021-R7 - LDL Pheresis
CV-I-0022-R12- Echocardiography (Transthoracic, Transesophageal, and Doppler)*
CV-I-0023 - Multislice or Multidetector Computed Tomographic Angiography of the Heart
and great Vessels
DIG-I-0005-R1 - Virtual Colonoscopy (CT COLONOGRAPHY)
DRUG-I-0008-R6 - Pamidronate Disodium for Injection (Aredia)
DRUG-I-0010-R15 - Erythropoietin Analogues, Epoetin Alfa and Darbepoetin Alfa *
DRUG-I-0011-R19 - Intravenous Immunoglobulin (IVIG)
DRUG-I-0030-R4 - Algucerase (ceredase)and Imiglucerase (cerezyme
L20387 - Stretta Procedure *
L25507 - Psychiatric Inpatient Hospitalization *
L25650 - Homocycteine Level Serum
L4333 - Diagnostic Mammography *
L4336 - Audiology Services *
L4339 - Outpatient Physical Therapy*
L4340 - Chronic Pulmonary Disease Treatment Services *
L4342 - Removal of Skin Lesions *
L553 - Botulinum Toxin Type A
L663 - Cardiovascular Imaging Studies *
LAB-I-0020-R12 - Flow Cytometry
LAB-I-0022-R7 - Reticulocyte Counts
MED-I-0002-R4 - Diabetic Outpatient Self-management Training Services
MED-I-0021-R6 - Debridement of the Toenails
MED-I-0023-R3 - Visual Rehabilitation Services *
MED-I-0025-R3 - Avulsion or Excision of Toenail Plate *
MUS-I-0001-R10 - Bone Mass Measurement *
NERU-I-0010 - Vagal Nerve Stimulation (VNS) for Depression
PMR-I-0003-R2 Inpatient Rehabilitation *
PMR-I-0011 - Skilled Nursing Facilities (Including Swing Beds)*
PSYCH -I-0001-R7- Partial Hospitalization Program *
RAD-I-0003-R15 - Magnetic Resonance Angiography (MRA)
RAD-I-0020-R10 - Transrectal Prostatic Ultrasound and Prostatic Needle Biospy
RAD-I-0021-R1 - Radiation Oncology Part I *
RAD-I-0021-R9 - Breast Ultrasound/Echography
RAD-I-0022 - Radiation Oncology Part II *
RAD-I-0023 - Radiation Oncology Part III *
RAD-I-0024 - Radiation Oncology Part IV *
RAD-I-0025-R4 - Proton Beam Radiation Therapy *
RAD-I-0026-R17 - Computerized Axial Tomography (CT scan), Head or Brain
RAD-I-0027-R14 - Computerized Axial Tomography (CT scan): Pelvis,Abdomen
RAD-I-0028-R11 - Magnetic Resonance (e.g. Proton) Imaging of the Spine
RAD-I-0029-R12 - Magnetic Resonance (e.g. Proton) Imaging of the Brain
RAD-I-0030-R9 - Magnetic Resonance (e.g. Proton) Imaging, Abdomen
RAD-I-0031-R15 - Magnetic Resonance (e.g. Proton) Imaging of the Orbit, Face, and Neck
RAD-I-0032 - PillCam TM ESO
RAD-I-0034 - Wireless Capsule Endoscopy

* = Not-All-Inclusive Policies
190.12 Culture, Bacterial, Urine
190.13 Human Immunodeficiency Virus Testing (Prognosis including Monitoring)
190.14 Human Immunodeficiency Virus Testing (Diagnosis)
190.15 Blood Counts
190.16 Partial Thromboplastin Time
190.17 Prothrombin Time
190.18 Serum Iron Studies
190.19 Collagen Crosslinks, Any Method
190.20 Blood Glucose Testing
190.21 Glycated Hemoglobin / Glycated Protein
190.22 Thyroid Testing
190.23 Lipids
190.24 Digoxin Therapeutic Drug Assay
190.25 Alpha-fetoprotein
190.26 Carcinoembryonic Antigen
190.27 Human Chorionic Gonadotropin
190.28 Tumor Antigen by Immunoassay -CA125
190.29Tumor Antigen by Immunoassay CA15-3/CA27.29
190.30 Tumor Antigen by Immunoassay CA19-9
190.31 Prostate Specific Antigen
190.32 Gamma Glutamyl Transferase
190.33 Hepatitis Panel
190.34 Fecal Occult Blood
Medicare National Coverage Decisions (NCD)