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LCD L37031: BDX-XL2

LCD L37031, BDX-XL2, is the Local Coverage Determination that Palmetto GBA applies to claims from 7 states (AL, GA, NC, SC, TN, VA, WV), effective 2022-04-28 and first in force 2017-07-10. The policy text runs 99 words, and its billing and coding article A56929 lists 2 ICD-10-CM codes that support medical necessity for 1 procedure codes. 2 other contractors 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
2022-04-28
Original effective
2017-07-10
Policy text
99 words
Covered ICD-10 codes (articles)
2

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 L37031
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 A56929 (Billing and Coding: BDX-XL2) 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.

A56929: Billing and Coding: BDX-XL2 (Billing and Coding, effective 2023-09-21)

Covered ICD-10-CM codes
2
2 groups
Non-covered ICD-10-CM codes
0
Procedure codes listed
1
Full article
cms.gov record
First 2 covered ICD-10-CM codes in A56929
ICD-10-CMDescription (FY2027)
R91.1—
R91.8—

Procedure codes: 0080U.

Coverage indications, limitations and medical necessity

This Medicare contractor will provide limited coverage for the BDX-XL2 test (Biodesix, Seattle, WA) for the management of a lung nodule, between 8 and 30mm in diameter, in patients 40 years or older and with a pre-test cancer risk (as assessed by the Mayo Clinic Model for Solitary Pulmonary Nodules) of 50% or less. The intended use of the test is to assist physicians in the management of lung nodules by identifying those lung nodules with a high probability of being benign. These lung nodules would then be candidates for non-invasive computed tomography (CT) surveillance instead of invasive procedures.

Summary of evidence (opening)

Lung nodules are rounded densities, under 30mm in diameter, detected by chest radiograph (CXR) or CT scan. Nodules are mostly surrounded by lung tissue and are also called coin lesions, solitary pulmonary nodules or lesions, or a “spot” on the lung. The edges of a nodule can be described as smooth or irregular (stellate or spiculated) with irregular edges somewhat more indicative for cancer. Heavily calcified nodules with smooth edges are generally benign and solid nodules that have not shown growth over time are considered benign. For a comprehensive review of nodules and their evaluation, see the 2-part series by Patel, et al . 1,2

Lung nodules are detected incidentally or through lung cancer screening. Lung cancer screening now has Medicare coverage in the United States (US). As of April 26, 2016, there were 806 sites registered for screening. 22 The estimated number of new lung nodules incidentally detected annually in the US is 1.57 million, whereas it is anticipated that another 1.5 million are detected by screening annually in the US. 3

Early detection of lung nodules is an opportunity to reduce lung cancer mortality, but it comes with significant risks. These risks are both for patients and health care delivery networks. For patients, a major problem is the risk of unnecessary invasive procedures to find the minority of nodules that are cancer. For health care delivery, the risks are both costs and overloading the health care system.

Of the expected 3 million nodules per year found incidentally or by lung cancer screening, the majority will be Medicare age. Four recent studies underscore the importance of lung cancer evaluations to the Medicare population:

The contractor cites 22 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.

Dates, lineage and related policies

Original determination effective
2017-07-10
Current revision effective
2022-04-28
Last reviewed by the contractor
2022-03-09
MCD version
35

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.

L37054
Noridian Healthcare Solutions, LLC · 18 states · revised 2025-10-23 · 2 covered codes
L37216
Wisconsin Physicians Service Insurance Corporation · 48 states · revised 2023-03-30 · 2 covered codes

Frequently asked questions

What does LCD L37031 cover?

This Medicare contractor will provide limited coverage for the BDX-XL2 test (Biodesix, Seattle, WA) for the management of a lung nodule, between 8 and 30mm in diameter, in patients 40 years or older and with a pre-test cancer risk (as assessed by the Mayo Clinic Model for Solitary Pulmonary Nodules) of 50% or less. The intended use of the test is to assist physicians in the management of lung nodules by identifying… 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 L37031 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 L37031?

The companion billing and coding article A56929 lists 2 ICD-10-CM codes in 2 groups that support medical necessity; the first 2 appear on this page and the complete list is in the article on cms.gov.

How do I appeal a denial under LCD L37031?

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.