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LCD ID Number: L33633 Status: A-Approved
LCD Title: Magnetic Resonance Angiography (MRA)
Geographic Jurisdiction: Rhode Island 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 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).
CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 6 – Hospital Services Covered Under Part B:
20.4 Outpatient Diagnostic Services.
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services:
80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests.
CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Part 4:
220.2 Magnetic Resonance Imaging
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 13 – Radiology Services and Other Diagnostic Procedures:
40.1 Magnetic Resonance Angiography
CMS Transmittal No. 7040, Publication 100-03, Medicare National Coverage Determinations (NCD)Manual, Change Request #7040, July 9, 2010, Magnetic Resonance Angiography (MRA).
CMS Transmittal No. 2045, Publication 100-04, Medicare Claims Processing Manual, Change Request #7147, September 10, 2010, October 2010 Update of the Ambulatory Surgical Center (ASC) Payment System.
CMS Transmittal No. 2050, Publication 100-04, Medicare Claims Processing Manual, Change Request #7117, September 17, 2010, October 2010 Update of the Hospital Outpatient Prospective Payment System (OPPS).
CMS Transmittal No. 2051, Publication 100-04, Medicare Claims Processing Manual, Change Request #7112, September 17, 2010, October Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB).
National Coverage Analysis (NCA); Magnetic Resonance Angiography of the Abdomen and Pelvis (CAG-00142N). http://www.cms.hhs.gov/ncdr/memo.asp?id=51. Accessed June 4, 2003.
National Coverage Determination. Magnetic Resonance Angiography. Publication 6. http://www.cms.hhs.gov/ncd/searchdisplay.asp?NCD_ID=178&NCD_vrsn_num=2. Accessed June 4, 2003.
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