CodeMap® LCD-L36386

Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor

Contractor Number: 02401
Contractor Type: MAC A

LCD Information

LCD ID Number: L36386 Status: A-Approved
LCD Title: MolDX: Breast Cancer Assay: Prosigna®
Geographic Jurisdiction: Washington Other Jurisdictions
Original Determination Effective Date: 05/03/2016
Original Determination Ending Date:
Revision Effective Date: 04/22/2021
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act (SSA), §1862(a)(1)(A), states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”

42 Code of Federal Regulations (CFR) §410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests and §80.1.1 Certification Changes

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01/22/2025 02:19:07 18.97.9.171

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