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CodeMap® LCD-L37379


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LCD for Echocardiography (L37379)
See related Articles:
A56625-Billing and Coding: Echocardiography

Contractor Information

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

Contractor Number: 11201

Contractor Type: MAC A

LCD Information

LCD ID Number: L37379 Status: A-Approved

LCD Title: Echocardiography

Geographic Jurisdiction: South Carolina Other Jurisdictions

Original Determination Effective Date: 09/18/2017

Original Determination Ending Date:

Revision Effective Date: 06/10/2021

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 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) excludes routine physical examinations

Title XVIII of the Social Security Act, §1862(a)(1)(D) indicates no payment may be made in the case of clinical care where items and services provided are in research and experimentation

42 CFR §410.32(a) diagnostic tests must be ordered by the physician who is treating the beneficiary, and who uses the results in the management of the beneficiary's specific medical problem

42 CFR §411.15(k)(1) Particular services excluded from coverage

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.6 Requirements for Ordering and Following Orders for Diagnostic Tests, §80.6.1 Definitions, §80.6.2 Interpreting Physician Determines a Different Diagnostic Test is Appropriate, §80.6.3 Rules for Testing Facility to Furnish Additional Tests, §80.6.4 Rules for Testing Facility Interpreting Physician to Furnish Different or Additional Tests

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §220.5 Ultrasound Diagnostic Procedures

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12/03/2023 01:12:42

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