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LCD for Diagnostic and Therapeutic Colonoscopy (L36868)
See related Articles:
A55558-Response to Comments: Diagnostic and Therapeutic Colonoscopy
A57343-Billing and Coding: Diagnostic and Therapeutic Colonoscopy

Contractor Information

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

Contractor Number: 03302

Contractor Type: MAC B

LCD Information

LCD ID Number: L36868 Status: A-Approved

LCD Title: Diagnostic and Therapeutic Colonoscopy

Geographic Jurisdiction: North Dakota Other Jurisdictions

Original Determination Effective Date: 07/17/2017

Original Determination Ending Date:

Revision Effective Date: 10/01/2019

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, §1862(a)(7) and 42 Code of Federal Regulations, §411.15 et seq. exclude routine physical examinations.

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

Title XVIII of the Social Security Act, §1862(a)(1)(H) and Balanced Budget Act ‘97’, Chapter V, Subtitle B, §4104 provides coverage for colorectal cancer screening tests.

CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, §30.1B, addresses incomplete colonoscopies.

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07/17/2024 07:22:55

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