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 |
|---|---|---|---|
| 11201 | Palmetto GBA | A and B and HHH MAC | SC |
| 11301 | Palmetto GBA | A and B and HHH MAC | VA |
| 11401 | Palmetto GBA | A and B and HHH MAC | WV |
| 11501 | Palmetto GBA | A and B and HHH MAC | NC |
| 11202 | Palmetto GBA | A and B and HHH MAC | SC |
| 11302 | Palmetto GBA | A and B and HHH MAC | VA |
| 11402 | Palmetto GBA | A and B and HHH MAC | WV |
| 11502 | Palmetto GBA | A and B and HHH MAC | NC |
| 10111 | Palmetto GBA | A and B MAC | AL |
| 10211 | Palmetto GBA | A and B MAC | GA |
| 10311 | Palmetto GBA | A and B MAC | TN |
| 10112 | Palmetto GBA | A and B MAC | AL |
| 10212 | Palmetto GBA | A and B MAC | GA |
| 10312 | Palmetto GBA | A and B MAC | TN |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56612 (Billing and Coding: CT of the Head) 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.
A56612: Billing and Coding: CT of the Head (Billing and Coding, effective 2026-10-01)
- Covered ICD-10-CM codes
- 7587
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 12
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| A06.6 | — |
| A17.0 | — |
| A17.1 | — |
| A17.81 | — |
| A17.82 | — |
| A17.83 | — |
| A17.89 | — |
| A17.9 | — |
| A27.81 | — |
| A39.0 | — |
| A39.1 | — |
| A39.2 | — |
| A39.3 | — |
| A39.4 | — |
| A39.81 | — |
| A41.9 | — |
| A81.00 | — |
| A81.01 | — |
| A81.09 | — |
| A81.1 | — |
| A81.2 | — |
| A81.81 | — |
| A81.83 | — |
| A81.89 | — |
Procedure codes: 70450, 70460, 70470, G2187 (Patients With Clinical Indications For Imaging Of The Head: Head Trauma), G2188 (Patients With Clinical Indications For Imaging Of The Head: New Or Change In Headache Above 50 Years Of Age), G2189 (Patients With Clinical Indications For Imaging Of The Head: Abnormal Neurologic Exam), G2190 (Patients With Clinical Indications For Imaging Of The Head: Headache Radiating To The Neck), G2191 (Patients With Clinical Indications For Imaging Of The Head: Positional Headaches), G2192 (Patients With Clinical Indications For Imaging Of The Head: Temporal Headaches In Patients Over 55 Years Of Age), G2193 (Patients With Clinical Indications For Imaging Of The Head: New Onset Headache In Pre-School Children Or Younger (<6 Years Of Age)), G2194 (Patients With Clinical Indications For Imaging Of The Head: New Onset Headache In Pediatric Patients With Disabilities For Which Headache Is A Concern As Inferred From Behavior), G2195 (Patients With Clinical Indications For Imaging Of The Head: Occipital Headache In Children).
Coverage indications, limitations and medical necessity
A cranial computerized tomographic (CT) scan is a very useful and informative neurodiagnostic tool. Scanning of the head in successive layers by a narrow beam of x-rays enables the transmission of x-ray photons in each layer to be measured. A computer is used to process the accumulated x-ray photon data and constructs a graphic image of a tomographic slice. Normal intracranial structures and a wide variety of intracranial disorders may be demonstrated. A cranial CT scan may be ordered without contrast, with injection of standard roentgenographic contrast material or without contrast material, followed by contrast material and further sections. Contrast administration is not without risk to the patient and for some conditions adds little or no benefit to the examination.
Cranial CT scans are determined to be reasonable and necessary and are a covered service when the patient has clinical evidence of an intracranial disorder or an established intracranial disorder or disease. The general indications for use of contrast CT scanning are:
1. To assess perfusion (e.g., cerebrovascular accident [CVA])
2. To characterize a specific lesion
3. To detect defects in blood/brain barrier (e.g., infarcts, tumors, infection, vasculitis)
4. To detect neovascularity (tumors); or
5. For staging of known lung cancer, breast cancer, and lymphomas which are likely to metastasize early to the brain
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
- 2023-08-17
- Last reviewed by the contractor
- 2023-07-05
- MCD version
- 57
- Derived from
- L31576
The contractor lists one National Coverage Determination as related: NCD 220.1 Computed Tomography. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
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 Palmetto GBA hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34417 cover?
A cranial computerized tomographic (CT) scan is a very useful and informative neurodiagnostic tool. Scanning of the head in successive layers by a narrow beam of x-rays enables the transmission of x-ray photons in each layer to be measured. A computer is used to process the accumulated x-ray photon data and constructs a graphic image of a tomographic slice. Normal intracranial structures and a wide variety of… 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 L34417 apply to?
Palmetto GBA applies it to Medicare claims in AL, GA, NC, SC, TN, VA, WV. 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 L34417?
The companion billing and coding article A56612 lists 7,587 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 L34417?
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.