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LCD for MRI and CT Scans of the Head and Neck (L35175)
See related Articles:
A56067-Response to Comments: MRI and CT Scans of Head and Neck
A57215-Billing and Coding: MRI and CT Scans of the Head and Neck

Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor

Contractor Number: 03302

Contractor Type: MAC B

LCD Information

LCD ID Number: L35175 Status: A-Approved

LCD Title: MRI and CT Scans of the Head and Neck

Geographic Jurisdiction: North Dakota Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 10/01/2019

Revision End Date:

CMS National Coverage Policy:

Title XVIII of the Social Security Act, Section 1862(a)(7) excludes routine physical examinations. This provision excludes screening examinations.

Title XVIII of the Social Security Act, Section 1862(a)(1)(A) allows coverage and payment for only those services that are considered reasonable and necessary.

Title XVIII of the Social Security Act, Section 1833(e) prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act, Section 1862(a)(1)(D) prohibits Medicare payment for services and items that are experimental or investigational.

CMS publication 100-3, Medicare National Coverage Determinations, Sections 220.1 “Computerized Tomography”, and 220.2-220.2.B.2d and Section 220.2.C-220.2.D “Magnetic Resonance Imaging”.

Denies coverage of MRI for:

  1. Imaging of cortical bone and calcification;
  2. Procedures involving spatial resolution of bone or calcification;
  3. MRI is not covered for patients with metallic clips on vascular aneurysms

CMS publication 100-04 Medicare Claims Processing Manual Chapter 13 Section 40.

Denies coverage of MRI for:

  1. Measurement of blood flow and spectroscopy

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07/17/2024 09:02:48

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