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Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor Contractor Number: 14512 Contractor Type: MAC B

LCD Information

LCD ID Number: L33585 Status: A-Approved LCD Title: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography Geographic Jurisdiction: Vermont Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 10/24/2019 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. 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 410.34 specifies the conditions for and limitation on coverage. 42 CFR, Section 486 specifies the conditions for coverage of portable x-ray services. CMS Publications: CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15: 80.4.3 Scope of Portable X-Ray Benefit CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15: 80.4.4 Exclusions From Coverage as Portable X-Ray Services CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15: 80.6 Requirements for Ordering and Following Orders for Diagnostic Tests CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1: 220.5 Ultrasound Diagnostic Procedures CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 13: 90 Services of Portable X-Ray Suppliers Sorry, you need to login or register to view additional sections of this Medicare policy. *