LCD ID Number: L37535 Status: A-Approved
LCD Title: Vitamin D Assay Testing
Geographic Jurisdiction: Illinois Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
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CMS National Coverage Policy:
Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.
42CFR410.32(a) requires a clinical diagnostic test be ordered by the physician who is treating the patient for a specific medical problem and uses the results in the management of the beneficiary’s specific problem.
MBPM Internet Only Manual (IOM 100-02), Chapter 6, Section 20.4.3 applies 42CFR410.32 to hospitals.
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