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LCD ID Number: L35092 Status: A-Approved
LCD Title: Diagnostic Abdominal Aortography and Renal Angiography
Geographic Jurisdiction: Colorado Other Jurisdictions
Original Determination Effective Date:
10/01/2015
Original Determination Ending Date:
Revision Effective Date:
11/07/2019
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 diagnostic abdominal aortography and renal angiography 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 diagnostic abdominal aortography and renal angiography 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:
IOM Citations:
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual
- Chapter 6, Section 10 Medical and Other Health Services Furnished to Inpatients of Participating Hospitals, and Section 20.4 Outpatient Diagnostic Services
- Chapter 15, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
- Chapter 16, Section 20 Services Not Reasonable and Necessary.
- CMS IOM Publication 100-04, Medicare Claims Processing Manual
- Chapter 1, Section 30.2.9 Payment to Physician or Other Supplier for Diagnostic Tests Subject to the Anti-Markup Payment Limitation- Claims Submitted to A/B Macs (B)
- Chapter 3, Section 40.3 Outpatient Services Treated as Inpatient Services
- Chapter 4, Section 20.6 Use of Modifiers
- Chapter 13, Radiology Services and Other Diagnostic Procedures
- Chapter 23, Section 20.9 National Correct Coding Initiative (NCCI)
- CMS IOM 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD
Other:
- National Correct Coding Initiative (NCCI) Coding Policy Manual for Medicare Services, Chapter IX, Radiology Services, Section D: Interventional/Invasive Diagnostic Imaging, Effective January 1, 2018
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(d)(3) indicates diagnostic tests are payable only when ordered by the physician or nonphysician practitioner (NPP) who is treating the beneficiary for a specific medical problem and who uses the results in such treatment.
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