LCD ID Number: L35448 Status: A-Approved
LCD Title: Independent Diagnostic Testing Facility (IDTF)
Geographic Jurisdiction: New Jersey 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 independent diagnostic testing facilities. 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 independent diagnostic testing facilities 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, Sections 60 and 80
- CMS IOM Publication 100-03, Medicare National Coverage Determinations Manual,
- Chapter 1, Part 1, Section 20.25
- Chapter 1, Part 4, Section 240.4
- CMS IOM Publication 100-04, Medicare Claims Processing Manual,
- Chapter 1, Sections 10 and 30.2
- Chapter 35
- CMS IOM Publication 100-08, Medicare Program Integrity Manual,
- Chapter 3, Section 184.108.40.206
- Chapter 10, Section 10.2.2, I
- Chapter 13, Section 13.5.4
Social Security Act (Title XVIII) Standard References:
- 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.
- 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.
Federal Register References:
- CFR, Title 42, Chapter IV, Subchapter B, Part 410, Subpart B,
- Section 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.
- Section 410.33 Independent diagnostic testing facility.
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