LCD ID Number: L35007 Status: A-Approved
LCD Title: Vestibular and Audiologic Function Studies
Geographic Jurisdiction: New Jersey Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determination(s) or payment policy rules and regulations for vestibular and audiology services. 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 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 vestibular and audiology services 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:
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Sections 80.3 Audiology Services and 80.6 Requirements for Ordering and Following Orders for Diagnostic Tests
- CMS IOM Publication 100-04, Medicare Claims Processing Manual:
- Chapter 12, Section 30.3 Audiology Services
- Chapter 13, Section 10 ICD Coding for Diagnostic Tests
- 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 1833 (e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim
- Title XVIII of the Social Security Act, Section 1861 (II)(2) addresses payment to Audiologists
- Title XVIII of the Social Security Act, Section 1861(II)(3)(B) addresses qualifications of Audiologists
- Title XVIII of the Social Security Act, Section 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 Social Security Act, Section 1862 (a)(7). This section excludes routine physical examinations
Federal Register References:
- Title 42 Code of Federal Regulations (CFR) section 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests
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