CodeMap® LCD-L37260

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11502
Contractor Type: MAC B

LCD Information

LCD ID Number: L37260 Status: A-Approved
LCD Title: MolDX: Prometheus® IBD sgi Diagnostic® Policy
Geographic Jurisdiction: North Carolina Other Jurisdictions
Original Determination Effective Date: 09/26/2017
Original Determination Ending Date:
Revision Effective Date: 02/29/2024
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.

42 CFR §410.32(a) Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostics tests: Conditions

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

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12/10/2024 06:56:55 18.97.14.84

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