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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 10211 Contractor Type: MAC A

LCD Information

LCD ID Number: L34434 Status: A-Approved LCD Title: Upper Gastrointestinal Endoscopy and Visualization Geographic Jurisdiction: Georgia 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 Sorry, you need to login or register to view additional sections of this Medicare policy. *