LCD ID Number: L37283 Status: A-Approved
LCD Title: Electrocardiograms
Geographic Jurisdiction: Washington 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, 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.
Medicare's Carrier's Manual (MCM), §15047(D), explains coverage for preoperative diagnostic tests performed to determine a patient's perioperative risks and optimize perioperative care. (The reference will be crosswalked to the CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, §184.108.40.206 as soon as it become available.)
Medicare Carriers Manual, §15047(G), explains how to report preoperative tests. (The reference will be crosswalked to the CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, §220.127.116.11 as soon as it becomes available.)
CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, §20.3(E), describes bundling of payment for ECG services supplied concomitantly with other physician services.
CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 13, §100.1, states that in general only one payment is made for one interpretation of an EKG.
CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 23, §20.9.1. Correct Coding Initiative (CCI) describes correct usage of the 59 modifier for repeat procedural services performed on the same day.
CMS Manual System, Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, §20.15, Electrocardiogram Service, "No payment is made for EKG interpretations by individuals other than physicians' and "A separate charge by an attending or consulting physician for EKG interpretation is allowed only when it is the normal practice to make such charge".
CMS Manual System, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, §§190 and 200, allow for services supplied by physician assistants and nurse practitioners.
CMS Manual System, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, §250, states that payment may be made under Part B for the medical and other health services enumerated in paragraph C, but only where no payment can be made for such services under Part A.
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