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Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor Contractor Number: 03102 Contractor Type: MAC B

LCD Information

LCD ID Number: L36680 Status: A-Approved LCD Title: Lab: Bladder/Urothelial Tumor Markers Geographic Jurisdiction: Arizona 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 Sorry, you need to login or register to view additional sections of this Medicare policy. *