CodeMap® LCD-L33418

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11202
Contractor Type: MAC B

LCD Information

LCD ID Number: L33418 Status: R- Retired
LCD Title: Assays for Vitamins and Metabolic Function
Geographic Jurisdiction: South Carolina Other Jurisdictions
Original Determination Effective Date: 10/01/2015
Original Determination Ending Date: 01/28/2023
Revision Effective Date: 12/10/2020
Revision End Date: 01/28/2023
CMS National Coverage Policy:
Title XVIII of the Social Security Act, §1862 (a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

42 Code of Federal Regulations (CFR) §410.32 indicates that diagnostic tests are payable only when ordered by the physician who is treating the beneficiary for a specific medical problem and who uses the results in such treatment.

Federal Register, Vol. 66, No. 226, November 23, 2001, pp. 58788–58890 addresses coverage and administrative policies for clinical diagnostic laboratory services.

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.4.3 Coverage of Outpatient Diagnostic Services Furnished on or Before December 31, 2009

CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §230.19 Levocarnitine for Use in the Treatment of Carnitine Deficiency in ESRD Patients

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