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CodeMap® LCD-L34998

 

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L34998
LCD for Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (L34998)
See related Articles:
A57072-Billing and Coding: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder
A59262-Response to Comments: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder

Contractor Information

Contractor Name: Novitas Solutions, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 12401

Contractor Type: MAC A

LCD Information

LCD ID Number: L34998 Status: A-Approved

LCD Title: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder

Geographic Jurisdiction: New Jersey Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 12/11/2022

Revision End Date:

CMS National Coverage Policy:

This LCD supplements but does not replace, modify, or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for transcranial magnetic stimulation (TMS) in adults with severe major depressive disorder. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify, or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations, and rules for Medicare payment for TMS and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:

IOM Citations:

  • CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
    • Chapter 15, Section 60 Services and Supplies
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD


Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment may be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
  • Section 1862(a)(1)(D) prohibits the payment for clinical care items and services for research and experimentation which are not reasonable and necessary.


Code of Federal Regulations (CFR) References:

  • CFR, Title 21, Volume 8, Chapter I, Subpart H, Part 882, Subpart F, Section 882.5802 Transcranial Magnetic Stimulation System for Neurological and Psychiatric Disorders and Conditions.
  • CFR, Title 21, Volume 8, Chapter I, Subpart H, Part 882, Subpart F, Section 882.5805 Repetitive transcranial magnetic stimulation system.


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02/08/2023 08:48:56 44.211.239.1


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