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CodeMap® LCD-L34614


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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: 08202

Contractor Type: MAC B

LCD Information

LCD ID Number: L34614 Status: A-Approved

LCD Title: Colonoscopy and Sigmoidoscopy-Diagnostic

Geographic Jurisdiction: Michigan Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 03/28/2024

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.

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06/13/2024 06:33:03

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