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CodeMap® LCD-L37539


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LCD for MolDX: Prometheus IBD sgi Diagnostic® Policy (L37539)
See related Articles:
A55879-Response to Comments: MolDX: Prometheus IBD sgi Diagnostic Policy (L37539)
A57588-Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy

Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor

Contractor Number: 05201

Contractor Type: MAC A

LCD Information

LCD ID Number: L37539 Status: A-Approved

LCD Title: MolDX: Prometheus IBD sgi Diagnostic® Policy

Geographic Jurisdiction: Kansas Other Jurisdictions

Original Determination Effective Date: 03/19/2018

Original Determination Ending Date:

Revision Effective Date: 02/25/2021

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.”

42 Code of Federal Regulations (CFR) §410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions indications that diagnostic tests may only be ordered by the treating physician (or other treating practioner acting with the scope of his or her license and Medicare requirements).

CMS Manual, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.0 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 services.

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06/22/2021 07:31:53

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