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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 10211 Contractor Type: MAC A

LCD Information

LCD ID Number: L36761 Status: A-Approved LCD Title: GlycoMark® Testing for Glycemic Control Geographic Jurisdiction: Georgia Other Jurisdictions Original Determination Effective Date: 10/17/2016 Original Determination Ending Date: Revision Effective Date: 07/27/2023 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 be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements). 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, §80.1.1 Certification Changes, §80.1.2 A/B MAC (B) Contacts With Independent Clinical Laboratories Sorry, you need to login or register to view additional sections of this Medicare policy. *