LCD ID Number: L33562 Status: A-Approved
LCD Title: Computed Tomographic (CT) Colonography for Diagnostic Uses
Geographic Jurisdiction: Maine Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Language quoted from 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 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) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).
42 CFR Section 410.38, subpart B indicates the tests approved for coverage of colorectal cancer screening
CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1:
220.1 Computed Tomography
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15:
80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 13:
10 ICD-9-CM Coding for Diagnostic Tests
20 Payment Conditions for Radiology Services
80 Supervision and Interpretation (S & I) Codes and Interventional Radiology
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06/07/2023 01:03:12 188.8.131.52