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CodeMap® LCD-L38229

 

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L38229
LCD for Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (L38229)
See related Articles:
A56642-Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)
A57732-Response to Comments: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)

Contractor Information

Contractor Name: Novitas Solutions, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 12101

Contractor Type: MAC A

LCD Information

LCD ID Number: L38229 Status: A-Approved

LCD Title: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)

Geographic Jurisdiction: Delaware Other Jurisdictions

Original Determination Effective Date: 12/30/2019

Original Determination Ending Date:

Revision Effective Date: 12/30/2019

Revision End Date:

CMS National Coverage Policy:

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for gastrointestinal pathogen (GIP) panels utilizing multiplex nucleic acid amplification techniques (NAATs). Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for GIP panels utilizing multiplex (NAATs) and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site.

Internet Only Manual (IOM) Citations:

  • CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 Covered Medical and Other Health Services, Section 80.1 Clinical Laboratory Services
  • CMS IOM Publication 100-04, Medicare Claims Processing Manual,
    • Chapter 16 Laboratory Services
    • Chapter 23 Fee Schedule Administration and Coding Requirements, Section 10 Reporting ICD Diagnosis and Procedure Codes and Section 20.9 National Correct Coding Initiative (NCCI)
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 13 Local Coverage Determinations, Section 13.5.4 Reasonable and Necessary Provision in an LCD

Social Security Act (Title XVIII) Standard References:

  • 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.
  • 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.

Federal Register References:

  • Title 42 Code of Federal Regulations (CFR), Volume 2, Chapter IV, Part 410.32, Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.
  • Title 42 Code of Federal Regulations (CFR), Volume 2, Chapter IV, Part 411.15(a), Particular services excluded from coverage.


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10/17/2021 05:29:30 3.239.50.33


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