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LCD ID Number: L36039 Status: A-Approved
LCD Title: Total Joint Arthroplasty
Geographic Jurisdiction: Vermont Other Jurisdictions
Original Determination Effective Date:
12/01/2015
Original Determination Ending Date:
Revision Effective Date:
10/10/2019
Revision End Date:
CMS National Coverage Policy:
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.
Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:
Title XVIII of the Social Security Act (SSA):
Section 1862 (a)(1)(A) allows coverage and payment for only those services that are considered to be 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.
Code of Federal Regulations:
Title 21 CFR, Chapter 1, Subchapter H, Part 888 orthopedic devices, arthroscope.
Title 42 CFR §482.24 documentation for medical records.
IOM:
CMS Publication 100-08, Medicare Program Integrity Manual:
Chapter 6, §6.5.2, Medical Review of Acute IPPS Hospital or LTCH.
Chapter 13, §3.4.1.3, diagnosis code requirement.
CMS Publication 100-02, Medicare Benefit Policy Manual:
Chapter 7- Home Health Services, §40.2.1 - General Principles Governing Reasonable and Necessary Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy, defines activities of daily living (ADLs).
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