LCD ID Number: L35035 Status: A-Approved
LCD Title: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography
Geographic Jurisdiction: Mississippi Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
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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 thoracic aortography and carotid, vertebral, and subclavian angiography. 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 thoracic aortography and carotid, vertebral, and subclavian angiography 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 Covered Medical and Other Health Services, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
- CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual,
- Chapter 1, Part 1, Section 20.7 Percutaneous Transluminal Angioplasty (PTA)
- Chapter 1, Part 4, Section 220.9 Digital Subtraction Angiography (DSA)
- CMS IOM Publication 100-04, Medicare Claims Processing Manual,
- Chapter 12 Physicians/Nonphysican Practitioners, Section 100.1.5 Other Complex or High Risk Procedures
- Chapter 13 Radiology Services and Other Diagnostic Procedures, Section 40.1 Magnetic Resonance Angiography (MRA)
- Chapter 23 Fee Schedule Administration and Coding Requirements, Section 20.9 National Correct Coding Initiative (NCCI)
- NCCI Coding Policy Manual for Medicare Services
- Chapter V Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic Systems, Section D Cardiovascular System
- Chapter IX Radiology Services, Section D: Interventional/Invasive Diagnostic Imaging
- CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13 Local Coverage Determinations, 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 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: Conditions-documentation requirements for clinical review.
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08/08/2022 03:02:56 22.214.171.124