Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 15102 | CGS Administrators, LLC | MAC - Part B | KY |
| 15202 | CGS Administrators, LLC | MAC - Part B | OH |
| 15101 | CGS Administrators, LLC | MAC - Part A | KY |
| 15201 | CGS Administrators, LLC | MAC - Part A | OH |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56811 (Billing and Coding: Transcatheter Infusion Therapy) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A56811: Billing and Coding: Transcatheter Infusion Therapy (Billing and Coding, effective 2025-09-25)
- Covered ICD-10-CM codes
- 53
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 5
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| G45.9 | — |
| I60.01 | — |
| I60.02 | — |
| I60.11 | — |
| I60.12 | — |
| I60.2 | — |
| I60.31 | — |
| I60.32 | — |
| I60.4 | — |
| I60.51 | — |
| I60.52 | — |
| I60.6 | — |
| I60.8 | — |
| I61.0 | — |
| I61.1 | — |
| I61.3 | — |
| I61.4 | — |
| I61.5 | — |
| I61.6 | — |
| I61.8 | — |
| I62.01 | — |
| I62.02 | — |
| I62.03 | — |
| I62.1 | — |
Procedure codes: 37211, 37212, 37213, 61650, 61651.
Coverage indications, limitations and medical necessity
Abstract:
For the purpose of this LCD, Transcatheter Therapy is defined as the infusion of medication (other than chemotherapy and thrombolysis) through an inserted arterial (angiographic) catheter for the purpose of delivering specific medication to a localized vascular bed. Therapeutic infusion of medications is covered for indications identified in the LCD, when other routes of administration are not appropriate or effective. The treatment is reimbursable as a single service, regardless of the duration of the infusion.
Indications:
Transcatheter infusion therapy is indicated for the prolonged therapeutic administration (infusion) of a medication through a previously inserted arterial angiographic catheter for the purpose of delivering the medication to an individual vascular bed. Such administration assumes that the drug could not be delivered effectively via any other route (e.g., sublingual, intravenous, intramuscular, subcutaneous, etc) and must be infused via the indwelling catheter to be effective.
Infusion is defined as the prolonged, continuous administration of the medication through the catheter lasting a minimum of 30 minutes. It may require the use of an infusion pump. Bolus, "push" or "slow push" injections are not infusions.
Transcatheter infusions may be indicated for the treatment of:
• cerebrovasospasm
• bleeding involving the head or neck
• gastrointestinal hemorrhage
• non-occlusive mesenteric ischemia.
• Raynaud's syndrome
• Medications for which infusion is a reimbursable service include:
• nitroglycerin (for cerebrovascular spasm, only)
• neosynephrine
• vasopressin
• somatastatin
• papaverine
• reserpine
Limitations:
Transcatheter administration of medications or other biologics for reasons other than treatment (e.g., medications administered for diagnostic purposes; contrast agents administered for imaging) and medications administered incidental to a diagnostic procedure, albeit for therapeutic reasons (e.g., nitroglycerin administered intra-coronary during coronary angiography), are not covered or reimbursable under this code.
CPT codes for transcatheter infusion therapy is reimbursable only once per encounter, regardless of the number of medications infused or duration of the infusion beyond 30 minutes.
Infusions for the treatment of primary pulmonary hypertension are considered investigational and will be denied as not medically necessary.
Infusions for medications normally given by bolus or "push" technique or by another route will be denied as not medically necessary.
Summary of evidence (opening)
N/A
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2026-09-03
- Last reviewed by the contractor
- 2026-08-14
- MCD version
- 24
- Derived from
- L31906
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the CGS Administrators, LLC hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34084 cover?
For the purpose of this LCD, Transcatheter Therapy is defined as the infusion of medication (other than chemotherapy and thrombolysis) through an inserted arterial (angiographic) catheter for the purpose of delivering specific medication to a localized vascular bed. Therapeutic infusion of medications is covered for indications identified in the LCD, when other routes of administration are not appropriate or… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34084 apply to?
CGS Administrators, LLC applies it to Medicare claims in KY, OH. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34084?
The companion billing and coding article A56811 lists 53 ICD-10-CM codes in 1 group that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34084?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.