LCD ID Number: L35490 Status: A-Approved
LCD Title: Category III Codes
Geographic Jurisdiction: Iowa Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Social Security Acts
- Title XVIII of the Social Security Act (SSA): Section 1862(a) (1) (A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- 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) refers to limitations on items or devices that are investigational or experimental.
CMS IOM Citations
- CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 14- Medical Devices, Section 10, Coverage of Medical Devices.
- CMS Publication 100-03 Medicare Benefit Policy Manual, Chapter 1, Part 1, Section 20.4 Implantable Automatic Defibrillators.
- CMS Publication 100-03 Medicare Benefit Policy Manual, Chapter 1, Part 2, Section 150.13 Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS); and Part 4, Section 310 Clinical Trials.
- CMS Publication 100-04, Medicare Benefit Policy Manual, Chapter 23- Fee Schedule Administration and Coding Requirements, Section 30 Services paid under the Medicare Physicians Fee Schedule.
- CMS Publication 100-04 Claims Processing Manual, Chapter 32, Section 68 Investigational Device Exemptions (IDE) Studies, and Section 330 Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS).
- CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Sect.13.5.4 Reasonable and necessary provisions in LCDs & 13.5.3 Evidentiary Content
- CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.2.4- Proposed LCD.
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