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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: L34537 Status: A-Approved LCD Title: Vestibular Function Testing Geographic Jurisdiction: North Carolina Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 09/09/2021 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations. 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, §1861(ll)(3) and (ll)(4)(B) defines Speech-Language Pathology Services and Audiology Services. CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.3 Audiology Services and §80.3.1 Definition of Qualified Audiologist CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §3.2.3 Requesting Additional Documentation During Prepayment and Postpayment review 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). 42 CFR §410.33 Independent diagnostic testing facility HCFA Ruling 95-1 is binding on providers, contractors, appeal levels, and an Administrative Law Judge. Ruling 95-1 describes limitations on the usage of limitation of liability (SSA, §1879).  Sorry, you need to login or register to view additional sections of this Medicare policy. *