LCD ID Number: L35409 Status: A-Approved
LCD Title: Non-Vascular Extremity Ultrasound
Geographic Jurisdiction: Oklahoma 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 non-vascular extremity ultrasound 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 non-vascular extremity ultrasound 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:
- CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Section 220.5 Ultrasound Diagnostic Procedures
- CMS IOM Publication 100-04, Medicare Claims Processing Manual,
- Chapter 1, Section 30.2.9 Payment to Physician or Other Supplier for Purchased Diagnostic Tests Subject to the Anti-Markup Payment Limitation-Claims Submitted to A/B MACs (B)
- Chapter 13, Sections 10.1 Billing Part B Radiology Services and Other Diagnostic Procedures, 20 Payment Conditions for Radiology Services, and 150 Place of Service (POS) Instructions for the Professional Component (PC or Interpretation) and the Technical Component (TC) of Diagnostic Tests
- Chapter 16, Section 40.2 Payment Limit for Purchased Services
- 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:
- Title 42 Code of Federal Regulations (CFR) section 410.32(d)(3) Diagnositic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions, Diagnostic laboratory tests - Claims review.
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