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LCD ID Number: L37379 Status: A-Approved
LCD Title: Echocardiography
Geographic Jurisdiction: North 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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