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Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor Contractor Number: 05401 Contractor Type: MAC A

LCD Information

LCD ID Number: L34614 Status: A-Approved LCD Title: Colonoscopy and Sigmoidoscopy-Diagnostic Geographic Jurisdiction: Nebraska Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 08/29/2024 Revision End Date: CMS National Coverage Policy: Social Security Act (Title XVIII) Title XVIII of the Social Security Act, § 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury. Title XVIII of the SSA, §1833(e), prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Title XVIII of the Social Security Act, § 1862(a)(7). This section excludes routine physical examinations. CFR, Title 42, Ch. IV, § 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. Sorry, you need to login or register to view additional sections of this Medicare policy. *