CodeMap® LCD-L34454

Contractor Information

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

Contractor Number: 11502
Contractor Type: MAC B

LCD Information

LCD ID Number: L34454 Status: A-Approved
LCD Title: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Geographic Jurisdiction: North Carolina Other Jurisdictions
Original Determination Effective Date: 10/01/2015
Original Determination Ending Date:
Revision Effective Date: 04/29/2021
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act §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.

42 CFR §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).
CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.2 Outpatient Defined, §20.3 Encounter Defined, §20.4.1 Diagnostic Services Defined, §20.4.4 Coverage of Outpatient Diagnostic Services Furnished on or After January 1, 2010
CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §30.1B Digestive System - Incomplete Colonoscopies

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12/11/2024 01:01:59 18.97.14.89

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