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CMS Transmittals

CodeMap® LCD-L35408


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LCD for 3D Interpretation and Reporting of Imaging Studies (L35408)
See related Articles:
A56526-Billing and Coding: 3D Interpretation and Reporting of Imaging Studies

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: L35408 Status: R- Retired

LCD Title: 3D Interpretation and Reporting of Imaging Studies

Geographic Jurisdiction: Delaware Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date: 09/28/2023

Revision Effective Date: 10/31/2019

Revision End Date: 09/28/2023

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 3D interpretation reporting of imaging studies. 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 3D interpretation reporting of imaging studies 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 15, Section 80.6 Requirements for Ordering and Following Orders for Diagnostic Tests.
  • CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, 100-03, Chapter 1, Part 2, Section 160.24 Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease, Part 4, Section 220.1 Computed Tomography (CT) and Section 220.2 Magnetic Resonance Imaging (MRI).
  • CMS IOM 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). This section 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)(7). This section excludes routine physician examinations.
  • Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary.

Federal Registration References:

  • 42 CFR 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions
  • 42 CFR 410.33 Independent diagnostic testing facility

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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.

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12/03/2023 02:14:28

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