LCD ID Number: L35080 Status: A-Approved
LCD Title: Select Minimally Invasive GERD Procedures
Geographic Jurisdiction: Illinois Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.
Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:
Title XVIII of the Social Security Act (SSA):
Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Section 1862(a)(7) excludes routine physical examinations, unless otherwise covered by statute.
Code of Federal Regulations:
42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).
Sorry, you need to login or register to view additional sections of this Medicare policy.
All information on this web site is compiled directly from information obtained from the Center
for Medicare and Medicaid Services (CMS) and from its Contractors.
CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on
this web site. However, the ultimate responsibility for correct coding and claims submission lies with the
provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information
is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims.
Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.
No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
12/01/2022 01:58:18 126.96.36.199