LCD ID Number: L35408 Status: A-Approved
LCD Title: 3D Interpretation and Reporting of Imaging Studies
Geographic Jurisdiction: Pennsylvania Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
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 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:
- 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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