LCD ID Number: L37299 Status: A-Approved
LCD Title: MolDX: Prometheus IBD sgi Diagnostic® Policy
Geographic Jurisdiction: California - Entire State 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, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member.
42 CFR § 410.32(a) indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).
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, §80.1.2 A/B MAC (B) Contacts With Independent Clinical Laboratories
Sorry, you need to login or register to view additional sections of this Medicare policy.
All information on this web site is compiled directly from information obtained from the Center
for Medicare and Medicaid Services (CMS) and from its Contractors.
CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on
this web site. However, the ultimate responsibility for correct coding and claims submission lies with the
provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information
is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims.
Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.
No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
12/01/2022 02:08:54 184.108.40.206