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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 10111 Contractor Type: MAC A

LCD Information

LCD ID Number: L33459 Status: A-Approved LCD Title: Computerized Axial Tomography (CT), Thorax Geographic Jurisdiction: Alabama Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 06/13/2024 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 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)(1)(D) items and services related to research and experimentation. Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups. 42 CFR §410.32(b)(3)(i), (b)(3)(ii), (b)(3)(iii) Levels of supervision CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.4.1 Diagnostic Services Defined, §20.4.3 Coverage of Outpatient Diagnostic Services Furnished on or Before December 31, 2009, §20.4.4 Coverage of Outpatient Diagnostic Services Furnished on or After January 1, 2010, and §20.4.5 Outpatient Diagnostic Services Under Arrangements CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §220.1 Computed Tomography (CT) Sorry, you need to login or register to view additional sections of this Medicare policy. *