CodeMap® LCD-L37913

Contractor Information

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

Contractor Number: 05401
Contractor Type: MAC A

LCD Information

LCD ID Number: L37913 Status: A-Approved
LCD Title: MolDX: Breast Cancer Index® (BCI) Gene Expression Test
Geographic Jurisdiction: Nebraska Other Jurisdictions
Original Determination Effective Date: 04/15/2019
Original Determination Ending Date:
Revision Effective Date: 02/23/2023
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 that "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of malformed body member."

42 Code of Federal Regulations (CFR) §410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

CMS Internet-Only Manual, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, §80.1.1 Certification Changes

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03/21/2025 10:18:58 18.97.9.168

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