CodeMap® LCD-L38371

Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 14512
Contractor Type: MAC B

LCD Information

LCD ID Number: L38371 Status: A-Approved
LCD Title: Multimarker Serum Tests Related to Ovarian Cancer Testing
Geographic Jurisdiction: Vermont Other Jurisdictions
Original Determination Effective Date: 07/01/2020
Original Determination Ending Date:
Revision Effective Date: 07/01/2020
Revision End Date:
CMS National Coverage Policy:
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 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1862(a)(7) excludes routine physical examinations, unless otherwise covered by statute.

Code of Federal Regulations:

42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 16:
20 Services Not Reasonable and Necessary

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10/05/2024 07:36:59 3.237.15.145

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