Revised LCD
January 3, 2007Effective January 1, 2007 the following list of ICD-9-CM Codes will be covered for CPT Code 86003
| 372.14 | Other Chronic Allergic Conjunctivitis |
| 381.00 – 381.06 | Acute Nonsuppurative Otitis Media Unspecified – Acute Allergic Sanguinous Otitis Media |
| 381.10 | Chronic Serous Otitis Media Simple Or Unspecified |
| 381.19 | Other Chronic Serous Otitis Media |
| 381.3 | Other And Unspecified Chronic Nonsuppurative Otitis Media |
| 381.4 | Nonsuppurative Otitis Media Not Specified As Acute Or Chronic |
| 381.50 – 381.52 | Eustachian Salpingitis Unspecified – Chronic Eustachian Salpingitis |
| 381.81 | Dysfunction Of Eustachian Tube |
| 382.9 | Unspecified Otitis Media |
| 466.0 | Acute Bronchitis |
| 471.0 | Polyp Of Nasal Cavity |
| 471.1 | Polypoid Sinus Degeneration |
| 471.8 | Other Polyp Of Sinus |
| 471.9 | Unspecified Nasal Polyp |
| 472.0 | Chronic Rhinitis |
| 474.00 – 474.02 | Chronic Tonsillitis – Chronic Tonsillitis And Adenoiditis |
| 474.10 – 474.12 | Hypertrophy Of Tonsil With Adenoids – Hypertrophy Of Adenoids Alone |
| 477.0 | Allergic Rhinitis Due To Pollen |
| 477.1 | Allergic Rhinitis Due To Food |
| 477.2 | Allergic Rhinitis, Due To Animal (Cat) (Dog) Hair And Dander |
| 477.8 | Allergic Rhinitis Due To Other Allergen |
| 477.9 | Allergic Rhinitis Cause Unspecified |
| 478.11 | Nasal Mucositis (Ulcerative) |
| 478.19 | Other Disease Of Nasal Cavity And Sinuses |
| 493.00 – 493.02 | Extrinsic Asthma Unspecified – Extrinsic Asthma With (Acute) Exacerbation |
| 493.10 – 493.12 | Intrinsic Asthma Unspecified – Intrinsic Asthma With (Acute) Exacerbation |
| 493.20 – 493.22 | Chronic Obstructive Asthma Unspecified – Chronic Obstructive Asthma With (Acute) Exacerbation |
| 493.90 – 493.92 | Asthma Unspecified – Asthma Unspecified With (Acute) Exacerbation |
| 691.8 | Other Atopic Dermatitis And Related Conditions |
| 692.9 | Contact Dermatitis And Other Eczema Unspecified Cause |
| 693.0 | Dermatitis Due To Drugs And Medicines Taken Internally |
| 693.1 | Dermatitis Due To Food Taken Internally |
| 693.8 | Dermatitis Due To Other Specified Substances Taken Internally |
| 693.9 | Dermatitis Due To Unspecified Substance Taken Internally |
| 708.0 | Allergic Urticaria |
| 708.8 | Other Specified Urticaria |
| 708.9 | Unspecified Urticaria |
| 781.1 | Disturbances Of Sensation Of Smell And Taste |
| 782.1 | Rash And Other Nonspecific Skin Eruption |
| 786.00 | Respiratory Abnormality Unspecified |
| 786.05 | Shortness Of Breath |
| 786.07 | Wheezing |
| 786.2 | Cough |
| 989.5 | Toxic Effect Of Venom |
| 989.82 | Toxic Effect Of Latex |
| 995.0 | Other Anaphylactic Shock Not Elsewhere Classified |
| 995.1 | Angioneurotic Edema Not Elsewhere Classified |
| 995.20 – 995.23 | Unspecified Adverse Effect Of Unspecified Drug, Medicinal And Biological Substance – Unspecified Adverse Effect Of Insulin |
| 995.27 | Other Drug Allergy |
| 995.29 | Unspecified Adverse Effect Of Other Drug, Medicinal And Biological Substance |
| 995.3 | Allergy Unspecified Not Elsewhere Classified |
| 995.60 – 995.69 | Anaphylactic Shock Due To Unspecified Food – Anaphylactic Shock Due To Other Specified Food |
| 995.7 | Other Adverse Food Reactions Not Elsewhere Classified |