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CodeMap® LCD-L34434

 

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L34434
LCD for Upper Gastrointestinal Endoscopy and Visualization (L34434)
See related Articles:
A56389-Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
A59127-Response to Comments: Upper Gastrointestinal Endoscopy and Visualization

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 10111

Contractor Type: MAC A

LCD Information

LCD ID Number: L34434 Status: A-Approved

LCD Title: Upper Gastrointestinal Endoscopy and Visualization

Geographic Jurisdiction: Alabama Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 08/14/2022

Revision End Date:

CMS National Coverage Policy:

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member

Title XVIII of the Social Security Act §1862(a)(7) excludes routine physical examinations

42 CFR 410.32(a) indicates that diagnostic tests may only be ordered by a treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements)

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, §100.2 Endoscopy, §100.4 Esophageal Manometry and §100.10 Injection Sclerotherapy for Esophageal Variceal Bleeding


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12/11/2024 12:24:17 18.97.14.89

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