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LCD ID Number: L35076 Status: A-Approved
LCD Title: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
Geographic Jurisdiction: Rhode Island Other Jurisdictions
Original Determination Effective Date:
10/01/2015
Original Determination Ending Date:
Revision Effective Date:
04/01/2020
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act (SSA):
Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Title XVIII of the Social Security Act, Section 1862(a)(1)(D). This section allows coverage and payment for only those services that are not investigational or experimental.
Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.
CMS Publications:
CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2:
Section 160.4 Stereotactic cingulotomy as a means of psychotherapy is investigational and non-covered.
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15:
Section 90 X-ray, Radium, and Radioactive Isotope Therapy
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