LCD ID Number: L35490 Status: A-Approved
LCD Title: Category III Codes
Geographic Jurisdiction: Kansas Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractor are prohibited from changing national language/wording
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.
- Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
- 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 National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.4 Implantable Automatic Defibrillators.
- CMS Publication 100-03 Medicare National Coverage Determinations 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 Claims Processing 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 Billing Requirements for Special Services.
- CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Sect.5.1 Reasonable and necessary provisions in LCDs & 7.1 Evidence supporting LCDs.
- CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.2.4- Proposed LCD.
Change Requests and References
- 8757 Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS).
- Transmittal 2805, CR 8401 Mandatory Reporting of an 8-Digit Clinical Trial Number on Claims.
- Transmittal 2959, CR 8757 Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS).
- Transmittal 3175, CR 8954 Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS) -Blinded Clinical Trial – Follow-Up CR to Implement a Second Claims Processing Procedure Code.
- Transmittal 3811, CR 10089 Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)
- Transmittal 4292, CR11293 Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2019 Update
- CMS CR 11328 July 2019 Quarterly Update of the Ambulatory Surgical Center (ASC) Payment System
- Transmittal No, 857, effective date October 3, 2018 Change Request 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019.
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