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Contractor Information

Contractor Name: Novitas Solutions, Inc. - Full list of policies of this Medicare Contractor Contractor Number: 04111 Contractor Type: MAC A

LCD Information

LCD ID Number: L35101 Status: A-Approved LCD Title: Psychiatric Codes Geographic Jurisdiction: Colorado Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 01/01/2024 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 psychiatric codes. 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 psychiatric codes 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 13, Section 100 Commingling and Section 110 Physician Services Chapter 15, Sections 60 Services and Supplies Furnished Incident To a Physician’s/NPP’s Professional Service, 80.2 Psychological and Neuropsychological Tests, 160 Clinical Psychologist Services, 170 Clinical Social Worker (CSW) Services, and 270 Telehealth Services CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 5, Section 100.4 Outpatient Mental Health Treatment Limitation Chapter 9, Section 60 Billing and Payment Requirements for RHCs and FQHCs Chapter 12, Sections 110 Physician Assistant (PA) Services Payment Methodology, 120 Nurse Practitioner (NP) And Clinical Nurse Specialist (CNS) Services Payment Methodology, 170 Clinical Psychologist Services, 190 Medicare Payment for Telehealth Services, and 210 Outpatient Mental Health Treatment Limitation 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, Sections: Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment may 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. Sorry, you need to login or register to view additional sections of this Medicare policy. *