| ID |
Title |
Effective Date |
Revision Effective Date |
End Date |
Last Approval / Revision Date |
| L25879 | Acid Phosphatase | 12/1/2007 | N/A | N/A | 9/20/2007 |
| L1281 | Acute Care: Inpatient, Observation and Treatment Room Services | 6/1/2002 | 12/31/2005 | N/A | 1/2/2008 |
| L13243 | Adenosine (Adenocard) | 9/30/2003 | 12/17/2005 | N/A | 10/2/2007 |
| L17635 | Alefacept Therapy | 9/29/2004 | 9/29/2004 | N/A | 10/30/2007 |
| L2483 | Ambulance Services | 9/30/2002 | 6/20/2006 | N/A | 5/22/2006 |
| L1290 | Anesthesia for Transvenous Pacemaker Insertion | 12/27/1996 | 7/27/2005 | N/A | 10/2/2007 |
| L15332 | Audiological Testing; Audiological Services | 3/10/2004 | 10/1/2007 | N/A | 2/18/2008 |
| L23482 | Audiology and Vestibular Function Tests | 9/30/2006 | N/A | N/A | 2/18/2008 |
| L1293 | Bacterial Culture | 10/19/1997 | 1/29/2005 | N/A | 9/17/2007 |
| L1348 | Barium Swallow (Video/Cine) | 10/16/1997 | 4/20/2006 | N/A | 10/4/2007 |
| L1002 | Barium Swallow Studies, Modified | 11/1/1997 | 10/1/2007 | N/A | 2/18/2008 |
| L26003 | Biologic Products for Wound Treatment and Surgical Interventions | 12/1/2007 | 3/1/2008 | N/A | 2/19/2008 |
| L1303 | Bladder Tumor Antigen | 7/1/1997 | 12/8/2005 | N/A | 10/2/2007 |
| L1306 | Blepharoplasty | 9/28/2000 | 12/9/2005 | N/A | 10/2/2007 |
| L2690 | Blepharoplasty | 3/23/2002 | 10/1/2004 | N/A | 6/8/2007 |
| L2545 | Blepharoplasty | 9/19/2001 | 10/1/2004 | N/A | 10/26/2007 |
| L24615 | Blepharoplasty/Blepharoptosis | 6/26/2000 | 7/6/2007 | N/A | 11/10/2007 |
| L23285 | Blepharoplasty/Blepharoptosis | 10/16/2006 | 7/6/2007 | N/A | 11/10/2007 |
| L26073 | BLOOD GLUCOSE Monitoring in a Skilled Nursing Facility (SNF) | 9/27/2007 | N/A | N/A | 10/4/2007 |
| L26071 | BLOOD GLUCOSE Monitoring in a Skilled Nursing Facility (SNF) | 9/27/2007 | N/A | N/A | 10/4/2007 |
| L1316 | Blood Glucose Testing | 2/20/1997 | 7/23/2005 | N/A | 2/18/2008 |
| L1343 | Bone Density Measurement | 1/1/1998 | 12/8/2005 | N/A | 1/11/2007 |
| L1321 | Botulinum Toxin Type A | 12/27/1996 | 10/1/2006 | N/A | 10/2/2007 |
| L22904 | Botulinum Toxin Type A and B | 10/16/2006 | 10/16/2006 | N/A | 12/19/2006 |
| L23309 | Botulinum Toxin Type A and B | 10/16/2006 | 10/16/2006 | N/A | 12/19/2006 |
| L26046 | Cancer Chemotherapeutic Agents | 9/27/2007 | 10/22/2007 | N/A | 11/15/2007 |
| L26044 | Cancer Chemotherapeutic Agents | 9/27/2007 | 10/22/2007 | N/A | 11/15/2007 |
| L20721 | Carboplatin | 9/30/2005 | 4/20/2006 | N/A | 6/21/2007 |
| L1068 | Cardiac Catheterization | 3/15/1999 | 10/27/2006 | N/A | 1/2/2008 |
| L15908 | Cardiac Catheterization | 7/2/2004 | 7/2/2006 | N/A | 6/8/2007 |
| L23480 | CARDIAC COMPUTED TOMOGRAPHY | 9/30/2006 | 9/30/2006 | N/A | 2/18/2008 |
| L25907 | Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) | 12/1/2007 | 3/1/2008 | N/A | 2/14/2008 |
| L912 | Cardiac Event Recorders | 5/28/1997 | 5/15/2006 | N/A | 2/18/2008 |
| L25447 | Cardiac Output Measurement Thoracic Electrical Bioimpedance | 12/1/2007 | 1/1/2008 | N/A | 12/20/2007 |
| L23499 | Cardiac Rehabilitation | 9/30/2006 | 9/30/2006 | N/A | 2/18/2008 |
| L2650 | Cardiac Rehabilitation Services | 8/10/2006 | 9/28/2006 | N/A | 6/8/2007 |
| L770 | Cardiovascular Stress Testing | 6/26/2000 | 10/1/2007 | N/A | 1/14/2008 |
| L22312 | Cardiovascular Stress Testing | 6/15/2006 | 10/1/2007 | N/A | 1/14/2008 |
| L2611 | Cardiovascular Stress Testing | 9/30/2002 | 10/1/2004 | N/A | 11/10/2007 |
| L13652 | CATARACT Surgery | 9/29/2003 | 9/27/2007 | N/A | 9/27/2007 |
| L23307 | CATARACT Surgery | 10/16/2006 | 9/27/2007 | N/A | 9/27/2007 |
| L2514 | Cataract Surgery | 6/15/2002 | 10/1/2004 | N/A | 6/11/2007 |
| L25275 | Category III CPT ® Codes | 12/1/2007 | 12/1/2007 | N/A | 2/18/2008 |
| L1081 | Chest X-Ray | 6/20/1996 | 7/20/2005 | N/A | 2/18/2008 |
| L15235 | Chest X-Ray | 5/29/2004 | 5/29/2004 | N/A | 2/18/2008 |
| L20620 | Clinically Complex Resourse Utilization Group ( RUG III) Category: Medicare Skilled Nursing Facility (SNF) | 9/30/2005 | 6/10/2006 | N/A | 6/18/2007 |
| L1116 | Colonoscopy | 12/27/1996 | 12/7/2005 | N/A | 9/10/2007 |
| L18329 | Colonoscopy, Diagnostic and Screening | 9/15/2004 | 10/1/2004 | N/A | 8/29/2006 |
| L25965 | Complex Cataract Extraction | 9/27/2007 | N/A | N/A | 10/4/2007 |
| L25939 | Complex Cataract Extraction | 9/27/2007 | N/A | N/A | 10/4/2007 |
| L23356 | Computed Coronary Tomography Angiography | 9/30/2006 | 9/30/2006 | N/A | 11/10/2007 |
| L25233 | Computed Tomographic (CT) Colongraphy | 12/1/2007 | N/A | N/A | 9/17/2007 |
| L24079 | Computed Tomographic Angiography of the Chest | 2/22/2007 | 12/20/2007 | N/A | 1/14/2008 |
| L24107 | Computed Tomographic Angiography of the Chest | 2/22/2007 | 12/20/2007 | N/A | 1/14/2008 |
| L934 | Computerized Axial Tomography of the Abdomen | 2/15/2000 | 10/1/2007 | N/A | 2/18/2008 |
| L14312 | Computerized Tomography (CT) Scans of the Abdomen and Pelvis | 9/13/2003 | 9/12/2007 | N/A | 9/12/2007 |
| L16266 | Cranial Computerized Tomography (CCT) Scans | 9/1/2004 | 10/1/2007 | N/A | 10/15/2007 |
| L23478 | CT Colonography (Virtual Colonoscopy) | 9/30/2006 | N/A | N/A | 10/30/2007 |
| L5658 | Dental Services | 8/2/2002 | 10/1/2004 | N/A | 9/4/2007 |
| L1130 | Diagnostic Mammogram | 10/16/1997 | 2/6/2007 | N/A | 9/10/2007 |
| L13302 | Dialysis Frequency | 9/30/2003 | 12/14/2005 | N/A | 6/27/2007 |
| L25820 | Drugs and Biologicals, Coverage of, for Label and Off-Label Uses | 12/1/2007 | 3/1/2008 | N/A | 2/21/2008 |
| L2603 | Dysphagia | 12/12/2000 | 7/10/2006 | N/A | 4/5/2007 |
| L1137 | Electrocardiogram | 4/1/1998 | 12/8/2005 | N/A | 2/18/2008 |
| L1241 | Electrocardiographic Monitoring for 24 Hours (Holter Monitoring) | 7/12/2000 | 12/9/2005 | N/A | 2/18/2008 |
| L14293 | Electrocardiographic Services (EKG/ECG) | 9/13/2003 | 10/1/2004 | N/A | 2/18/2008 |
| L14225 | Electroconvulsive Therapy (ECT) | 9/13/2003 | 10/1/2004 | N/A | 6/12/2007 |
| L1139 | Electrophysiology Studies (EPS) | 12/27/1996 | 7/27/2005 | N/A | 1/2/2008 |
| L25468 | Endoscopy by Capsule | 12/1/2007 | N/A | N/A | 2/18/2008 |
| L1938 | Epoetin Alfa (Epogen, EPO, Erythropoietin) | 9/29/2002 | 12/9/2005 | N/A | 9/28/2007 |
| L25639 | Erythrocyte Sedimentation Rate (ESR) | 12/1/2007 | N/A | N/A | 9/20/2007 |
| L22886 | Erythropoiesis Stimulating Agents (ESAs) | 10/16/2006 | 10/1/2007 | N/A | 1/14/2008 |
| L19875 | Erythropoiesis Stimulating Agents (ESAs) | 9/19/2005 | 10/1/2007 | N/A | 1/14/2008 |
| L23363 | Erythropoietic Agents | 9/29/2006 | N/A | N/A | 4/2/2007 |
| L1942 | Erythropoietin Analogs (Aranesp, Darbepoetin) | 9/29/2002 | 5/9/2006 | N/A | 2/18/2008 |
| L25211 | Erythropoietin Stimulating Agents (ESA) | 12/1/2007 | 3/1/2008 | N/A | 2/29/2008 |
| L986 | Erythropoietin Use in non-ESRD patients (non-dialysis) | 6/1/1999 | 10/1/2007 | N/A | 2/18/2008 |
| L20622 | Extensive Services Resource Utilization Group (RUG III) Category: Medicare Skilled Nursing Facility (SNF) | 9/30/2005 | 6/10/2006 | N/A | 6/18/2007 |
| L13281 | Extracorporeal Shock-Wave Therapy for Musculoskeletal Problems | 9/30/2003 | 12/17/2005 | N/A | 10/5/2007 |
| L998 | Eyelid and Brow Surgical Procedures | 8/15/2001 | 7/17/2007 | N/A | 10/1/2007 |
| L13232 | Ferrlecit and Venofer | 9/30/2003 | 12/14/2005 | N/A | 10/2/2007 |
| L1004 | Filgrastim (G-CSF), (Neupogen) | 6/1/1999 | 7/17/2007 | N/A | 2/18/2008 |
| L1009 | Flow Cytometry | 11/1/1997 | 10/1/2007 | N/A | 2/18/2008 |
| L1140 | Flow Cytometry | 12/27/1996 | 12/7/2005 | N/A | 9/10/2007 |
| L1162 | Ground Ambulance Services | 6/1/2002 | 9/17/2007 | N/A | 12/27/2007 |
| L1565 | HCG - Human chorionic gonadotropin-Tumor Antigen by Immunoassay, Qualitative | 7/1/1997 | 12/8/2005 | N/A | 10/5/2007 |
| L1029 | Helicobacter Pylori (H. pylori) | 6/1/1999 | 7/17/2007 | N/A | 2/18/2008 |
| L1641 | Hepatitis B (Serologic Testing) | 7/22/1995 | 2/8/2006 | N/A | 2/18/2008 |
| L25650 | Homocysteine Level, Serum | 12/1/2007 | N/A | N/A | 9/19/2007 |
| L22362 | Human Decellularized Dermal Matrix and Gel | 6/3/2006 | 9/28/2007 | N/A | 9/28/2007 |
| L1944 | Human Skin Equivalent (HSE) | 9/29/2002 | 1/25/2008 | N/A | 2/18/2008 |
| L25204 | Hyperbaric Oxygen Therapy (HBO) | 12/1/2007 | N/A | N/A | 9/19/2007 |
| L1242 | Ifosfamide (Ifex) | 2/20/1997 | 7/27/2005 | N/A | 2/18/2008 |
| L20616 | Impaired Cognition/Behavior/Reduced Physical Functions Resource Utilization Group (RUG III) Category: Medicare Skilled Nursing Facility (SNF) | 9/30/2005 | 6/10/2006 | N/A | 6/18/2007 |
| L1243 | Impotency Treatment | 12/27/1996 | 8/4/2005 | N/A | 9/17/2007 |
| L1244 | Indocyanine Green Angiography | 12/27/1996 | 12/7/2005 | N/A | 9/17/2007 |
| L1948 | Infliximab | 9/29/2002 | 12/9/2005 | N/A | 6/21/2007 |
| L25178 | Infrared Coagulation (IRC) of Hemorrhoids (R1) | 12/1/2007 | 1/1/2008 | N/A | 1/2/2008 |
| L1247 | Injectable Iron Preparation | 12/27/1996 | 7/19/2005 | N/A | 2/18/2008 |
| L1248 | Injection, Tendon Sheath, Ligament, Trigger Points or Ganglion Cyst | 12/27/1996 | 8/4/2005 | N/A | 10/2/2007 |
| L18183 | Inpatient Psychiatric Services | 11/15/2004 | 9/3/2005 | N/A | 9/28/2007 |
| L18887 | Inpatient Rehabilitation | 1/1/2005 | 7/17/2007 | N/A | 10/1/2007 |
| L19890 | Inpatient Rehabilitation Services | 5/14/2005 | 9/28/2006 | N/A | 9/4/2007 |
| L25714 | Inpatient Rehabilitation Services Provided in an Inpatient Rehabilitation Facility (IRF) | 12/1/2007 | 12/1/2007 | N/A | 11/6/2007 |
| L13228 | Intensity Modulated Radiation Therapy (IMRT) | 9/30/2003 | 4/25/2006 | N/A | 10/2/2007 |
| L1249 | Interventional Cardiology | 12/27/1996 | 12/7/2005 | N/A | 10/2/2007 |
| L1063 | Intravenous Immune Globulin (IVIG) | 8/15/2001 | 7/17/2007 | N/A | 10/1/2007 |
| L19866 | Intravenous Immune Globulin (IVIg) | 8/31/2005 | 8/29/2006 | N/A | 9/4/2007 |
| L1253 | Intravenous Immunoglobulin (IVIG) | 6/1/2002 | 1/1/2006 | N/A | 2/18/2008 |
| L23528 | Intravenous Inotropic Therapy Administered in the Outpatient Setting | 11/1/2006 | 7/17/2007 | N/A | 10/1/2007 |
| L2422 | Intravenous Iron Therapy | 6/15/2002 | 10/1/2004 | N/A | 9/28/2007 |
| L19503 | Intravenous Nesiritide (BNP) Infusion Therapy | 9/1/2005 | 7/17/2007 | N/A | 10/1/2007 |
| L2463 | Intravenous Vitamin D Analogues Usage for Dialysis Patients | 6/15/2002 | 10/1/2004 | N/A | 9/19/2007 |
| L1257 | Ionized Calcium | 2/20/1997 | 5/10/2005 | N/A | 2/18/2008 |
| L1951 | Kyphoplasty | 9/29/2002 | 12/9/2005 | N/A | 6/21/2007 |
| L22552 | Kyphoplasty | 6/3/2006 | 6/3/2006 | N/A | 9/19/2007 |
| L1264 | Laser Assisted Uvulopalatoplasty (LAUP) | 11/27/1996 | 8/4/2005 | N/A | 10/2/2007 |
| L897 | Leuprolide Acetate and Goserelin Acetate | 8/10/1997 | 7/17/2007 | N/A | 10/1/2007 |
| L1266 | Leuprolide/Goserelin | 10/16/1997 | 12/7/2005 | N/A | 10/2/2007 |
| L13187 | Levocarnitine | 8/30/2001 | 10/1/2004 | N/A | 6/18/2007 |
| L1326 | Lumbar Spine MRI | 12/27/1996 | 7/27/2005 | N/A | 2/18/2008 |
| L1338 | Lumbosacral Spine X-Ray | 12/27/1996 | 7/27/2005 | N/A | 2/18/2008 |
| L1329 | Magnesium | 5/1/1999 | 7/17/2007 | N/A | 2/18/2008 |
| L1340 | Magnesium | 2/20/1997 | 7/27/2005 | N/A | 9/17/2007 |
| L25367 | Magnetic Resonance Angiography (MRA) | 12/1/2007 | N/A | N/A | 9/19/2007 |
| L13225 | Mohs Micrographic Surgery (MMS) | 9/30/2003 | 12/9/2005 | N/A | 10/4/2007 |
| L12324 | Monoclonal Antibody Therapy; Ibritumomab Tiuxetan Therapeutic Regimen | 1/18/2003 | 10/1/2004 | N/A | 6/18/2007 |
| L1005 | Myocardial Perfusion Imaging | 8/10/1997 | 10/1/2007 | N/A | 11/10/2007 |
| L19826 | Natrecor® (Neseritide) Usage in the Treatment of Congestive Heart Failure | 8/31/2005 | 8/5/2006 | N/A | 9/28/2007 |
| L13239 | Neupogen (Filgrastim) and Neulasta (Pegfilgrastim) | 9/30/2003 | 12/14/2005 | N/A | 10/2/2007 |
| L25563 | Neuromuscular Junction Testing | 12/1/2007 | 12/1/2007 | N/A | 9/28/2007 |
| L13202 | Non-Covered Services | 9/30/2003 | 4/24/2006 | N/A | 2/18/2008 |
| L23336 | Non-invasive Cerebrovascular Arterial Studies | 11/30/2006 | 10/1/2007 | N/A | 1/14/2008 |
| L22315 | Non-invasive Cerebrovascular Arterial Studies | 6/15/2006 | 10/1/2007 | N/A | 1/14/2008 |
| L14311 | Non-Invasive Pulse Oximetry for Oxygen Saturation | 9/13/2003 | 10/1/2004 | N/A | 8/9/2007 |
| L1524 | Noninvasive Vascular Studies | 5/1/1995 | 10/1/2007 | N/A | 2/18/2008 |
| L1352 | Noninvasive Vascular Studies | 12/27/1996 | 12/7/2005 | N/A | 2/18/2008 |
| L2415 | Non-Invasive Vascular Studies for End Stage Renal Disease (ESRD) Patients | 6/15/2002 | 9/15/2005 | N/A | 9/19/2007 |
| L1363 | Occult Blood, Feces Testing | 10/16/1997 | 4/13/2007 | N/A | 1/2/2008 |
| L17637 | Occupational Therapy | 9/30/2005 | 9/11/2006 | N/A | 11/10/2007 |
| L13121 | Off-Label Coverage of FDA Approved Drugs and Biologicals | 9/30/2003 | 1/1/2007 | N/A | 2/18/2008 |
| L25347 | Ophthalmic Angiography (Fluorescein and Indocyanine Green) | 12/1/2007 | 12/1/2007 | N/A | 2/19/2008 |
| L25466 | Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) | 12/1/2007 | N/A | N/A | 2/18/2008 |
| L15815 | Outpatient Hospital Based Psychiatric Services | 6/1/2004 | 10/1/2006 | N/A | 10/26/2007 |
| L14319 | Outpatient Observation Services | 8/13/2003 | 9/19/2006 | N/A | 11/10/2007 |
| L2267 | Outpatient Occupational Therapy | 2/1/1997 | 9/29/2006 | N/A | 11/10/2007 |
| L2695 | Outpatient Physical Therapy | 8/18/2001 | 9/29/2006 | N/A | 11/10/2007 |
| L26219 | Outpatient Pulmonary Rehabilitation | 2/1/2008 | N/A | N/A | 12/13/2007 |
| L2627 | Outpatient Pulmonary Rehabilitation | 11/1/1999 | 1/1/2008 | N/A | 12/26/2007 |
| L23526 | Oxaliplatin | 11/1/2006 | 11/1/2006 | N/A | 2/18/2008 |
| L17632 | Oxaliplatin for Injection (Eloxatin™) | 7/15/2003 | 11/24/2004 | N/A | 10/30/2007 |
| L989 | Parathormone | 5/28/1997 | 10/1/2007 | N/A | 2/18/2008 |
| L1379 | Partial Hospitalization | 7/19/1995 | 7/27/2005 | N/A | 11/29/2007 |
| L2403 | Partial Hospitalization Program | 2/10/1995 | 10/1/2004 | N/A | 9/19/2007 |
| L1457 | Partial Psychiatric Hospitalization Program | 8/21/1991 | 7/17/2007 | N/A | 10/1/2007 |
| L1406 | Patient Education | 1/25/1995 | 7/26/2005 | N/A | 2/18/2008 |
| L1412 | Pelvic Echography for Prostate Follow-up | 12/27/1996 | 8/4/2005 | N/A | 10/5/2007 |
| L1413 | Percutaneous Transluminal Angioplasty in Renal Disease | 12/27/1996 | 12/7/2005 | N/A | 5/24/2007 |
| L1959 | Percutaneous Vertebroplasty | 9/29/2002 | 12/9/2005 | N/A | 6/21/2007 |
| L17639 | Physical Medicine and Rehabilitation Modalities | 9/30/2004 | 5/10/2007 | N/A | 6/22/2007 |
| L24618 | PHYSICAL Medicine and Rehabilitation Services, PT and OT | 7/6/2007 | 10/1/2007 | N/A | 2/18/2008 |
| L19471 | PHYSICAL Medicine and Rehabilitation Services, PT and OT | 6/20/2005 | 10/1/2007 | N/A | 2/18/2008 |
| L1642 | Potassium (Serum) | 12/27/1996 | 7/28/2005 | N/A | 2/18/2008 |
| L1426 | PRN Orders for Skilled Nursing Facilities | 4/1/1998 | 12/8/2005 | N/A | 10/5/2007 |
| L1428 | Prostatic Acid Phosphatase (PAP) | 10/16/1997 | 12/8/2005 | N/A | 10/5/2007 |
| L19783 | Psychiatric Inpatient Hospitalization | 9/1/2005 | 7/17/2007 | N/A | 10/1/2007 |
| L13725 | Psychiatric Inpatient Hospitalization | 12/6/2003 | 12/15/2005 | N/A | 9/28/2007 |
| L25507 | Psychiatric Inpatient Hospitalization | 12/1/2007 | 12/1/2007 | N/A | 9/21/2007 |
| L12225 | Psychiatric Partial Hospitalization Programs | 3/1/1999 | 10/1/2006 | N/A | 10/26/2007 |
| L1372 | Psychiatric Services-Outpatient Hospital based | 9/28/2000 | 12/9/2005 | N/A | 1/2/2008 |
| L1593 | Psychiatry and Psychology Services | 12/27/1996 | 1/1/2006 | N/A | 1/2/2008 |
| L1507 | Pulmonary Function Studies | 5/28/1997 | 10/1/2007 | N/A | 2/18/2008 |
| L1594 | Pulmonary Perfusion Imaging | 12/27/1996 | 8/6/2005 | N/A | 9/27/2007 |
| L1605 | Pulmonary Rehabilitation | 5/20/2002 | 12/31/2005 | N/A | 1/9/2007 |
| L5738 | Pulmonary Rehabilitation Services | 9/9/2001 | 10/28/2004 | N/A | 9/18/2007 |
| L1468 | Qualitative Drug Screen | 2/15/2000 | 12/15/2006 | N/A | 2/18/2008 |
| L22562 | Rehabilitation, Plus Extensive Services: Medicare Skilled Nursing Facility (SNF) | 4/21/2006 | 4/21/2006 | N/A | 8/8/2007 |
| L20618 | Rehabilitative Services Resource Utilization Group (RUG III) Category: Medicare Skilled Nursing Facility (SNF) | 9/30/2005 | 6/10/2006 | N/A | 8/8/2007 |
| L1597 | Removal Impacted Cerumen | 12/27/1996 | 7/28/2005 | N/A | 10/30/2007 |
| L1508 | Removal of Benign or Premalignant Skin Lesions | 5/28/1997 | 7/17/2007 | N/A | 11/10/2007 |
| L1865 | Removal of Benign Skin Lesions | 12/27/1996 | 3/31/2004 | N/A | 1/2/2008 |
| L13295 | Renal and Iliac Angiography and Aortography | 9/30/2003 | 12/14/2005 | N/A | 1/2/2008 |
|