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LCD L34554: In Vitro Chemosensitivity & Chemoresistance Assays

LCD L34554, In Vitro Chemosensitivity & Chemoresistance Assays, is the Local Coverage Determination that Palmetto GBA applies to claims from 7 states (AL, GA, NC, SC, TN, VA, WV), effective 2024-07-11 and first in force 2015-10-01. The policy text runs 12 words. 1 other contractor publish a policy with the same title, so the criteria that apply depend on where the service is furnished.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: Medicare Coverage Database LCD export release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (Thursdays) for the MCD.
Contractor
Palmetto GBA
States and territories
7
AL GA NC SC TN VA WV
Revision effective
2024-07-11
Original effective
2015-10-01
Policy text
12 words
Covered ICD-10 codes (articles)
0

Where this LCD applies

Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.

Contracts that apply LCD L34554
ContractContractorTypeStates
11201Palmetto GBAA and B and HHH MACSC
11301Palmetto GBAA and B and HHH MACVA
11401Palmetto GBAA and B and HHH MACWV
11501Palmetto GBAA and B and HHH MACNC
11202Palmetto GBAA and B and HHH MACSC
11302Palmetto GBAA and B and HHH MACVA
11402Palmetto GBAA and B and HHH MACWV
11502Palmetto GBAA and B and HHH MACNC
10111Palmetto GBAA and B MACAL
10211Palmetto GBAA and B MACGA
10311Palmetto GBAA and B MACTN
10112Palmetto GBAA and B MACAL
10212Palmetto GBAA and B MACGA
10312Palmetto GBAA and B MACTN

Billing and coding: diagnoses and procedure codes

Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56871 (Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays) 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.

A56871: Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays (Billing and Coding, effective 2025-01-01)

Covered ICD-10-CM codes
0
0 groups
Non-covered ICD-10-CM codes
0
Procedure codes listed
6
Full article
cms.gov record

Procedure codes: 0083U, 0248U, 0435U, 0525U, 84999, 89240.

Coverage indications, limitations and medical necessity

This is a noncoverage policy for the chemosensitivity and chemoresistance assays (CSRAs).

Summary of evidence (opening)

CSRAs

In order to avoid ineffective chemotherapy toxicity, the intent of CSRAs is to assist oncologists with the selection of chemotherapy drugs at initial diagnosis and tumor recurrence.

Chemosensitivity Assays

A chemotherapy sensitivity assay determines if a tumor growth is inhibited by a known chemotherapy drug or drug combination. Thus, the intent of the chemosensitivity assay is to assist the oncologist with effective chemotherapy agent selection.

The contractor cites 25 sources in the bibliography; 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
2024-07-11
Last reviewed by the contractor
2024-05-30
MCD version
34
Derived from
L31708

The contractor lists one National Coverage Determination as related: NCD 190.7 Human Tumor Stem Cell Drug Sensitivity Assays. 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.

The same policy title at other contractors

Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.

L37628
Noridian Healthcare Solutions, LLC · 18 states · revised 2025-10-16 · 1 covered codes

Frequently asked questions

What does LCD L34554 cover?

This is a noncoverage policy for the chemosensitivity and chemoresistance assays (CSRAs). 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 L34554 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 L34554?

The current export links no billing and coding article with a diagnosis list to this LCD, so coverage is decided on the indications in the policy text and the documentation in the record rather than by an automated diagnosis edit.

How do I appeal a denial under LCD L34554?

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.

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.