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CodeMap® LCD-L36538

 

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L36538
LCD for Treatment of Males with Low Testosterone (L36538)
See related Articles:
A55053-Response to Comments: Treatment of Males with Low Testosterone
A55056-Billing and Coding: Testopel Coverage
A57615-Billing and Coding: Treatment of Males with Low Testosterone

Contractor Information

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

Contractor Number: 01182

Contractor Type: MAC B

LCD Information

LCD ID Number: L36538 Status: A-Approved

LCD Title: Treatment of Males with Low Testosterone

Geographic Jurisdiction: California - Southern Other Jurisdictions

Original Determination Effective Date: 07/12/2016

Original Determination Ending Date:

Revision Effective Date: 11/01/2019

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.”

Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

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

CMS Internet Online Manual Pub. 100-02 (Medicare Benefit Policy Manual), Chapter 15, Section 80, “Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests”

CMS Internet-Only Manuals, Publication 100-04, Medicare Claims Processing Manual, Chapter 16, §50.5 Jurisdiction of Laboratory Claims, 60.12 Independent Laboratory Specimen Drawing, 60.2. Travel Allowance.

CMS Internet Online Manual Pub. 100-04 (Medicare Claims Processing Manual), Chapter 23 (Section 10) “Reporting ICD Diagnosis and Procedure Codes”.

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 12, §30-Correct Coding Policy


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11/13/2024 03:32:04 44.210.149.218

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