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LCD ID Number: L33579 Status: A-Approved
LCD Title: Transesophageal Echocardiography (TEE)
Geographic Jurisdiction: Vermont Other Jurisdictions
Original Determination Effective Date:
10/01/2015
Original Determination Ending Date:
Revision Effective Date:
10/01/2019
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 Section 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.
Section 1862(a)(7) of Title XVIII of the Social Security Act excludes routine physical examination, unless otherwise covered by statute.
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) and the results must be used in the management of the patient.
42 CFR, Section 410.33c, describes qualifications required for non-physician practitioners used by an IDTF.
CMS Publications:
CMS Publication 100-02, Medicare Coverage Issues Manual, Chapter 15:
80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 9:
100 General Billing Requirements
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12:
30.4 Cardiovascular System (Codes 92950-93799)
CMS Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 13:
20 Payment conditions for radiology services
National CCI Manual, version 13.3, Chapter II: CCI editing for anesthesia services; accessible at http://www.cms.hhs.gov/NationalCorrectCodInitEd/
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