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LCD for Respiratory Care (L37293)
See related Articles:
A55988-Response to Comments: Respiratory Care (Respiratory Therapy)
A57225-Billing and Coding: Respiratory Care
A59532-Response to Comments: Respiratory Care

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: L37293 Status: A-Approved

LCD Title: Respiratory Care

Geographic Jurisdiction: North Dakota Other Jurisdictions

Original Determination Effective Date: 07/09/2018

Original Determination Ending Date:

Revision Effective Date: 11/05/2023

Revision End Date:

CMS National Coverage Policy:

Language quoted from the Centers for Medicare & Medicaid Services (CMS) National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

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

Title XVIII of the Social Security Act, §1861(cc)(1) discusses CORF facility services.

Title XVIII of the Social Security Act, §1861(s)(2)(B) provides coverage of services incident to physician’s services furnished to hospital patients.

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.

42 CFR 485.70-CORF personnel qualifications- lists qualifications for respiratory therapists.

Federal Register: December 31, 2002 (Volume 67, Number 251) p 79999-80000 Final rule revisions to payment policies specific to G0237-G0239

CMS Manual System, Pub 100-02, Medicare Benefit Policy Manual, Chapter 6, §§20.4-20.4.1

CMS Manual System, Pub 100-02, Medicare Benefit Policy Manual, Chapter 8, §50.8.2

CMS Manual System, Pub 100-02, Medicare Benefit Policy Manual, Chapter 12, §§10, 20, 20.1, 20.2, 30, 30.1, and 40.5

CMS Manual System, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §240.7 and §240.8

CMS Manual System, Pub 100-20, One Time Notification, Transmittal 477, dated April 24, 2009, Change Request 6338

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07/17/2024 07:47:28

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