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Contractor Information

Contractor Name: Novitas Solutions, Inc. - Full list of policies of this Medicare Contractor Contractor Number: 12101 Contractor Type: MAC A

LCD Information

LCD ID Number: L35099 Status: A-Approved LCD Title: Frequency of Laboratory Tests Geographic Jurisdiction: Delaware 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 laboratory 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 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 laboratory 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 20.4 Outpatient Diagnostic Services Chapter 15, Section 80.1 Clinical Laboratory Services CMS IOM Publication 100-03, National Coverage Determination Manual, Chapter 1, Part 3, Sections 190.20 Blood Glucose Testing, 190.21 Glycated Hemoglobin/Glycated Protein, 190.22 Thyroid Testing, and 190.23 Lipid Testing CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 16, Laboratory Services Chapter 23, Section 10 Reporting ICD Diagnosis and Procedure codes and Section 40 Clinical Diagnostic Laboratory Fee Schedule 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 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: 42 CFR, Section 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests 42 CFR, Section 411.15 Particular services excluded from coverage 42 CFR, Section 410.38 Durable medical equipment: Scope and conditions Sorry, you need to login or register to view additional sections of this Medicare policy. *