Example: 93880 LCD in Texas
CPT 93880 in Texas returns 2 articles. The first, A52992 (Billing and Coding: Non-Invasive Cerebrovascular Arterial Studies), is applied by Novitas Solutions, Inc. (04411, 04412, 04911) and belongs to LCD L35397 (Non-Invasive Cerebrovascular Arterial Studies); it lists 358 covered ICD-10-CM codes. With diagnosis I65.23 (Occlusion and stenosis of bilateral carotid arteries) the answer for that article is "on the covered list", in groups 1 and 2. The table below runs the other worked examples against the same release; select a row to run it in the lookup above.
Computed from the MCD release 2026-10-08 store when this page was built. Each row is one article that lists the code in the state; the verdict is for the diagnosis shown.
| Code, state, diagnosis | Article | LCD | Diagnosis |
|---|---|---|---|
| 93880 · TX · I65.23 | A52992 | L35397 | On the covered list |
| 93880 · TX · I65.23 | A57592 | L35753 | On the covered list |
| 93880 · TX · R42 | A52992 | L35397 | Not on the covered list |
| 93880 · TX · R42 | A57592 | L35753 | On the covered list |
| 82306 · FL · E55.9 | A56841 | L33771 | On the covered list |
| 82306 · FL · E55.9 | A57484 | L34658 | On the covered list |
| 64483 · FL · M54.16 | A56651 | L33906, L39799 | On the covered list |
| 64483 · FL · M54.16 | A58777 | L39054 | On the covered list |
| 15823 · OH · Z41.1 | A56439 | L33944 | On the non-covered list |
| 15823 · OH · Z41.1 | A56908 | L34528 | Not on the covered list |
| G0283 · OH · M54.50 | A53057 | L34560 | Not on the covered list |
| G0283 · OH · M54.50 | A57067 | L34049 | Article has no diagnosis list |
How the answer is built
- Procedure codes
- 5,850
- 3,617 CPT, 2,233 HCPCS Level II
- Articles with code lists
- 1,020
- 1,013 Billing and Coding Articles in all
- Covered diagnosis rows
- 406,091
- 51,003 non-covered rows
- States and territories
- 56
Since 2019 Medicare contractors keep the codes for a local policy in a companion billing and coding article rather than in the LCD itself. Each article lists the procedure codes it governs, the ICD-10-CM codes that support medical necessity (in numbered groups, often with instructions saying which procedure codes a group applies to) and, for some policies, the diagnoses that are never covered. The lookup takes the procedure code, finds every current article that lists it, keeps the articles whose contractor has an active jurisdiction in the state, and reads the diagnosis against each article's lists. A group whose instructions name no procedure code is treated as applying to every code in the article; a group that names codes is treated as applying to those codes, and the instructions are shown so you can confirm.
Five verdicts are possible: the diagnosis is on the covered list for the code; it is covered only in a group whose instructions name other procedure codes; it is on the non-covered list; it is not on the covered list at all; or the article carries no diagnosis list, in which case coverage rests on the LCD's text and the record rather than on an automated diagnosis edit. Codes marked with an asterisk in the article come with a note (for example a requirement to report a second diagnosis), and the lookup shows it. A code that no article lists in the state is decided by the contractor claim by claim, unless a National Coverage Determination applies; the laboratory NCDs carry national diagnosis lists of their own.
Using the lookup before the claim and after a denial
Run the lookup when an order arrives for a service a local policy governs, so a diagnosis the article does not list is caught while the ordering clinician can still document a covered indication or the patient can be offered an Advance Beneficiary Notice. Run it again when a claim comes back with CARC 50 and remark N115: the remark names the LCD, and the article shows whether the billed diagnosis was the problem or whether the denial turns on frequency, documentation or a modifier. The LCD lookup guide explains how jurisdictions are assigned and the appeal path; each LCD page carries the full covered and non-covered lists of its articles; and the NCCI edit checker answers the separate question of whether two procedure codes can be paid together.
The lookup covers Medicare fee-for-service contractors only. Medicare Advantage plans and commercial payers publish their own coverage policies and are not answered here; the LCD variation report shows how far the contractors' own diagnosis lists differ for the same policy title, which is why the state is part of the question.
Where QuickIntell fits after the lookup
The lookup answers one code and one diagnosis at a time. QuickAuth coordinates requirement checks, documentation and submission before services that local policies govern, with human review of each case, and QuickRCM carries claim readiness and the CARC 50 and N115 denials afterwards.
Frequently asked questions
What does the LCD code lookup answer?
For one procedure code in one state it lists the Medicare billing and coding articles that name the code, the Local Coverage Determination or National Coverage Determination each article belongs to, and the contractor that applies it. With a diagnosis code it also says, article by article, whether that ICD-10-CM code is on the covered list, on the non-covered list or on neither.
Why does the state matter?
Local Coverage Determinations bind only the Medicare Administrative Contractor that wrote them, and each contractor's jurisdiction is a set of states. The same procedure can have a different diagnosis list, or no local policy at all, one state over. A few contracts are regional or national (the DME MACs, the home health and hospice MACs and one WPS Part A contract), so a state can return more than one article; use the one from the contract that processes the claim.
What does 'covered for other procedure codes' mean?
Articles split their covered diagnoses into groups, and a group's instructions often name the procedure codes it applies to. When the diagnosis is only in groups whose instructions name other codes of the article and not the one you entered, the lookup says so instead of reporting it as covered. Read the group instructions it shows before relying on the code pair.
Is a covered diagnosis enough for Medicare to pay?
No. The covered list is the automated edit; the LCD's indications, frequency limits, documentation requirements and modifier rules still apply, and a claim can be reviewed against the record later. A diagnosis that is not listed usually denies with CARC 50 and remark N115 unless the patient signed an Advance Beneficiary Notice before the service.
Why are CPT code descriptions missing?
CPT descriptors are copyrighted by the American Medical Association and QuickIntell does not hold a license to publish them, so CPT codes appear as bare numbers. HCPCS Level II descriptors are public and are shown, as are the ICD-10-CM descriptions (FY2027 code set).
How current is the lookup?
It is rebuilt from the weekly Medicare Coverage Database export (Billing and Coding Articles, LCDs and contractor jurisdictions) and the FY2027 ICD-10-CM code set. The release date is shown with every answer; check the article on cms.gov for changes published since.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file article.csvSHA-256 5e95c4a8ac3664be…
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file lcd.csvSHA-256 9aee1bd7f14056b0…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
Operational reference compiled from the CMS Medicare Coverage Database export. A covered diagnosis does not guarantee payment: coverage also depends on the LCD's indications, documentation and frequency limits, and on the contractor that processes the claim. CPT codes appear as bare numbers. Not legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.