LCD ID Number: L33557 Status: A-Approved
LCD Title: Cardiac Catheterization and Coronary Angiography
Geographic Jurisdiction: Vermont Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.
Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:
Title XVIII of the Social Security Act (SSA):
Section 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.
Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Code of Federal Regulations:
42 CFR Section 410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12:
100.1.5 Other Complex or High Risk Procedures
National Correct Coding Initiative Policy Manual for Medicare Services, version 14.3, Chapter 11, Section I Cardiovascular Services, Bullets 12, 15-19 and 21.
Federal Register, Vol. 75, No. 228, November 29, 2010, pages 167-169, Medicare Program; Final Rule for Payment Policies Under the Physician Fee Schedule for CY 2011
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