LCD ID Number: L37549 Status: A-Approved
LCD Title: Chest X-Ray Policy
Geographic Jurisdiction: Washington 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 (SSA), §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 or to improve the functioning of a malformed body member."
Title XVIII of the Social Security Act, §1862(a)(7) and 42 Code of Federal Regulations (CFR) §411.15(a)(1), exclude routine physical examinations.
Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.
CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80, Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, sets forth the levels of physician supervision required for furnishing the technical component of diagnostic tests for a Medicare beneficiary who is not a hospital inpatient or outpatient.
CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §§80.4-80.4.4, Coverage of Portable X-Ray Services Not Under the Direct Supervision of a Physician applicability of health and safety standards apply to all suppliers of portable x-ray services and the scope of portable x-ray benefit and exclusions from coverage as portable x-ray services.
CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §250, Medical and Other Health Services Furnished to Inpatients of Hospitals and Skilled Nursing Facilities including payments under arrangement.
42 CFR 486.100, stipulates that portable X-rays must comply with Federal, State, and local laws and regulations.
CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §220.127.116.11, Diagnoses Code Requirement.
42 Code of Federal Regulations, §410.32, addresses diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.
CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §§100 and 100.1, Interpretation of Diagnostic Tests describes how physicians should handle billing when two providers read a chest X-ray. Medicare will pay for the interpretation and report that directly contributes to the diagnosis and treatment of the individual patient.
CMS Manual System, Pub, 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.6.1, Definitions.
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