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LCD ID Number: L33627 Status: A-Approved
LCD Title: Non-Invasive Vascular Studies
Geographic Jurisdiction: New York - Queens 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.
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).
42 CFR, Section 410.33 provides guidelines for independent diagnostic testing facilities (IDTFs) including requirements for technician personnel and supervising physicians.
CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 11:
40 Other services, H. Noninvasive Vascular Studies for ESRD Patients
CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1:
20.17 Noninvasive Tests of Carotid Function
220.5 Ultrasound Diagnostic Procedures
CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13:
13.5.1 Reasonable and Necessary Provisions in LCDs
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06/03/2023 07:02:32 35.172.111.47
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