CodeMap® LCD-L33457

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: L33457 Status: A-Approved
LCD Title: Cardiac Radionuclide Imaging
Geographic Jurisdiction: South Carolina Other Jurisdictions
Original Determination Effective Date: 10/01/2015
Original Determination Ending Date:
Revision Effective Date: 03/23/2023
Revision End Date:
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.

Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations.

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §220.6.1 PET for Perfusion of the Heart (Various Effective Dates) and §220.12 Single Photon Emission Computed Tomograph (SPECT)

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05/13/2025 07:51:48 18.97.9.173

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