CodeMap® LCD-L38292

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: L38292 Status: A-Approved
LCD Title: MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
Geographic Jurisdiction: Alabama Other Jurisdictions
Original Determination Effective Date: 11/08/2020
Original Determination Ending Date:
Revision Effective Date: 07/25/2024
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 a malformed body member.

42 CFR §410.32(a) Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions

CMS Internet-Only Manual, Pub. 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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12/10/2024 06:00:16 18.97.14.84

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