CodeMap® LCD-L36427

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11502
Contractor Type: MAC B

LCD Information

LCD ID Number: L36427 Status: A-Approved
LCD Title: Wireless Capsule Endoscopy
Geographic Jurisdiction: North Carolina Other Jurisdictions
Original Determination Effective Date: 01/25/2016
Original Determination Ending Date:
Revision Effective Date: 10/28/2021
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act, §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

42 CFR 410.32(a) indicates that diagnostic tests may only be ordered by a treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements)

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §100.2 Endoscopy

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12/11/2024 01:02:29 18.97.14.89

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