LCD ID Number: L36868 Status: A-Approved
LCD Title: Diagnostic and Therapeutic Colonoscopy
Geographic Jurisdiction: Utah Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
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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