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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 10111 Contractor Type: MAC A

LCD Information

LCD ID Number: L37774 Status: A-Approved LCD Title: Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication Geographic Jurisdiction: Alabama Other Jurisdictions Original Determination Effective Date: 11/19/2018 Original Determination Ending Date: Revision Effective Date: 01/18/2024 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)(1)(D) items and services related to research and experimentation. Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups. 42 CFR §410.26 Services and supplies incident to a physician's professional services: Conditions. 42 CFR §410.27 Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or non-physician practitioner's service: Conditions. 42 CFR §410.32 (b)(3)(i)(ii) and (iii) Levels of supervision. CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §60.1-B Incident to Physician's Professional Services-Direct Personal Supervision and §60.2 Services of Nonphysician Personnel Furnished Incident to Physician's Services. CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 1, §20.35 Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Sorry, you need to login or register to view additional sections of this Medicare policy. *