Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57079 (Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma) 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.
A57079: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (Billing and Coding, effective 2026-01-01)
- Covered ICD-10-CM codes
- 662
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 9
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| G56.01 | — |
| G56.02 | — |
| G56.03 | — |
| G57.51 | — |
| G57.52 | — |
| G57.53 | — |
| G57.61 | — |
| G57.62 | — |
| G57.63 | — |
| M24.211 | — |
| M24.212 | — |
| M24.221 | — |
| M24.222 | — |
| M24.231 | — |
| M24.232 | — |
| M24.241 | — |
| M24.242 | — |
| M24.251 | — |
| M24.252 | — |
| M24.271 | — |
| M24.272 | — |
| M24.274 | — |
| M24.275 | — |
| M53.3 | — |
Procedure codes: 20526, 20527, 20550, 20551, 20612, 26341, 28899, 64455, 64632.
Coverage indications, limitations and medical necessity
This policy addresses the injection of chemical substances, such as local anesthetics, steroids, sclerosing agents and/or neurolytic agents into ganglion cysts, tendon sheaths, tendon origins/insertions, ligaments or near nerves of the feet (e.g., Morton's neuroma) to affect therapy for a pathological condition.
Note: the term "Morton's neuroma" is used in this policy generically to refer to a swollen inflamed nerve in the ball of the foot, including the more specific conditions of Morton's neuroma (lesion within the third intermetatarsal space), Heuter's neuroma (first intermetatarsal space), Hauser's neuroma (second intermetatarsal space) and Iselin's neuroma (fourth intermetatarsal space). This policy applies to each.
Injection of a carpal tunnel or tarsal tunnel is indicated for the patient with a mild case of these syndromes, with or without a trial of other conservative measures, such as oral non-steroidal anti-inflammatory drugs (NSAIDs) or orthoses.
Injection into tendon sheaths, ligaments, tendon origins or insertions, ganglion cysts, neuromas or other areas described by this policy may be indicated to relieve pain or dysfunction resulting from inflammation or other pathological changes. Proper use of this modality with local anesthetics and/or steroids should be short-term, as part of an overall management plan including diagnostic evaluation, in order to clearly identify and properly treat the primary cause. In some circumstances after diagnosis has been confirmed, injection of a sclerosing or neurolytic agent may be appropriate for longer-term management.
The signs or symptoms that justify these treatments should be resolved or reevaluated after one to three injections (see reference 2 below, under "Sources of Information and Basis for Decision"). Injections beyond three to the same tendon origin/insertion, tendon sheath, ganglion, neuroma, ligament or local area in a six month period must be justified by the clinical record indicating a logical reason for failure of the prior therapy and why further treatment can reasonably be expected to succeed. A recurrence may justify a second course of therapy.
Medical necessity for injections of more than two sites at one session or for frequent or repeated injections is questionable. Such injections are likely to result in a request for medical records which must evidence careful justification of necessity.
"Dry needling" of ganglion cysts, ligaments, neuromas, tendon sheaths and their origins/insertions are non-covered procedures.
Compliance with the provisions in this policy is subject to monitoring by post payment data analysis and subsequent medical review.
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
- 2025-09-11
- Last reviewed by the contractor
- 2021-03-02
- MCD version
- 26
- Derived from
- L33716
The contractor lists one National Coverage Determination as related: NCD 150.7 Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Other related documents: A55489 (Response to Comments), A55490 (Response to Comments).
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 Noridian Healthcare Solutions, LLC hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34218 cover?
This policy addresses the injection of chemical substances, such as local anesthetics, steroids, sclerosing agents and/or neurolytic agents into ganglion cysts, tendon sheaths, tendon origins/insertions, ligaments or near nerves of the feet (e.g., Morton's neuroma) to affect therapy for a pathological condition. 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 L34218 apply to?
Noridian Healthcare Solutions, LLC applies it to Medicare claims in AK, AS, AZ, CA, CNMI, GU, HI, ID, MT, ND, NF, NV, OR, SD, SF, UT, WA, WY. 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 L34218?
The companion billing and coding article A57079 lists 662 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 L34218?
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.