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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 11502 Contractor Type: MAC B

LCD Information

LCD ID Number: L33447 Status: A-Approved LCD Title: Special Electroencephalography Geographic Jurisdiction: North Carolina Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 09/19/2024 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations 42 CFR §410.32(b)(3)(i), (ii) and (iii) states that diagnostic tests must be ordered by the physician treating the patient 42 CFR §410.32(d)(1) addresses who may furnish Medicare Part B services for covered diagnostic tests CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.4.4 Coverage of Outpatient Diagnostic Services Furnished on or After January 1, 2010 CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests Sorry, you need to login or register to view additional sections of this Medicare policy. *