Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.
Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:
Title XVIII of the Social Security Act (SSA):
Section 1862(a)(1)(A) excludes expenses incurred 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.
Section 1862(a)(1)(D) refers to limitations on items or devices that are investigational or experimental.
Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 14,
10 Coverage of Medical Devices
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 23,
30 Services paid under the Medicare Physicians Fee Schedule
CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13,
5.1 Reasonable and necessary provisions in LCDs
7.1 Evidence supporting LCDs.
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