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LCD ID Number: L36678 Status: A-Approved
LCD Title: Lab: Bladder/Urothelial Tumor Markers
Geographic Jurisdiction: American Samoa, Guam, Hawaii, Northern Mariana Islands Other Jurisdictions
Original Determination Effective Date:
05/16/2017
Original Determination Ending Date:
Revision Effective Date:
03/04/2021
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act (SSA), §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.
Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups.
42 CFR §411.15 Particular Services Excluded From Coverage
42 CFR §410.32 Diagnostic X-ray Tests, Diagnostic Laboratory Tests, and Other Diagnostic Tests: Conditions
42 CFR §410.33 Independent Diagnostic Testing Facility
CMS Internet-Only Manual, Publication 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3 Diagnosis Code Requirements
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03/27/2023 04:37:04 34.232.62.64
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