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CodeMap® LCD-L36859

 

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L36859
LCD for Trigger Point Injections (TPI) (L36859)
See related Articles:
A55473-Response to Comments: Trigger Point Injections
A57702-Billing and Coding: Trigger Point Injections (TPI)
A59652-Response to Comments: Trigger Point Injections (TPI)

Contractor Information

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

Contractor Number: 03601

Contractor Type: MAC A

LCD Information

LCD ID Number: L36859 Status: A-Approved

LCD Title: Trigger Point Injections (TPI)

Geographic Jurisdiction: Wyoming Other Jurisdictions

Original Determination Effective Date: 05/26/2017

Original Determination Ending Date:

Revision Effective Date: 04/01/2024

Revision End Date:

CMS National Coverage Policy:

Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording.

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.

Title XVIII of the Social Security Act, §1862(a)(1)(D) Investigational or Experimental

IOM Citations:

  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,

~ Chapter 13, 13.5.4 Reasonable and Necessary Provision in an LCD

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
  • Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Code for Federal Regulations (CFR) References:

CFR, Title 42, Ch. IV, §410.74 Physician assistant's services, §410.75 Nurse practitioner's services and §410.76 Clinical nurse specialist's services.

NCDs

NCD 30.3.3 Acupuncture for Chronic Low Back Pain


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06/14/2024 10:53:21 100.28.2.72

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