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CodeMap® LCD-L34614

 

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L34614
LCD for Colonoscopy and Sigmoidoscopy-Diagnostic (L34614)
See related Articles:
A56394-Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic

Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor

Contractor Number: 05201

Contractor Type: MAC A

LCD Information

LCD ID Number: L34614 Status: A-Approved

LCD Title: Colonoscopy and Sigmoidoscopy-Diagnostic

Geographic Jurisdiction: Kansas Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 10/01/2020

Revision End Date:

CMS National Coverage Policy:

Social Security Act (Title XVIII)

  • Title XVIII of the Social Security Act (SSA or the Act), Section 1862(a) (1) (A), explains that payment may be allowed only for 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 SSA, Section 1833(e), prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
  • Title XVIII of the SSA, Section 1862(a)(7), states that Medicare will not cover any services or procedures associated with routine physical checkups.

42 Code of Federal Regulations, 410.32, Diagnostic X-Rays, diagnostic laboratory tests, and other diagnostic tests: Conditions. This section describes regulations that apply to performing these tests.

IOM Citations:

  • Pub 100-02, Medicare Benefit Policy Manual, Chapter 15 Covered Medical and Other Health Services:
  • Section 80-Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, Section 280.2 -Colorectal Cancer Screening
  • Pub.100-04 Medicare Claims Processing Manual -Chapter 18 Preventive and Screening Services: Section 60 - Colorectal Cancer Screening

CR 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019.


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06/22/2021 05:49:05 3.235.184.215


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