CodeMap® 
150 North Wacker Drive
Suite 2360
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule

2024
2023

Physician Fee Schedule

2024
2023

OPPS Fee Schedule

2024-October
2024-July

ASC Fee Schedule

2024-October
2024-July

APC Codes

2024-October
2024-July

DRG Codes

2024
2023

ASP Drug Pricing Files

2024-October
2024-July


CMS Transmittals




CodeMap® LCD-L38549

 

Printer Friendly Version

L38549
LCD for Transurethral Waterjet Ablation of the Prostate (L38549)
See related Articles:
A58008-Billing and Coding: Transurethral Waterjet Ablation of the Prostate
A59280-Response to Comments: Transurethral Waterjet Ablation of the Prostate

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11502

Contractor Type: MAC B

LCD Information

LCD ID Number: L38549 Status: A-Approved

LCD Title: Transurethral Waterjet Ablation of the Prostate

Geographic Jurisdiction: North Carolina Other Jurisdictions

Original Determination Effective Date: 12/27/2020

Original Determination Ending Date:

Revision Effective Date: 01/29/2023

Revision End Date:

CMS National Coverage Policy:

This Local Coverage Determination (LCD) supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Transurethral Waterjet Ablation of the Prostate. 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 Transurethral Waterjet Ablation of the Prostate 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 Centers for Medicare and Medicaid Services (CMS) manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS website:

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 14, §10 Coverage of Medical Devices

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 23, §30 Services paid under the Medicare Physicians Fee Schedule

CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.4 Reasonable and Necessary Provisions in an LCD

Social Security Act (Title XVIII) Standard References:

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations.


Sorry, you need to login or register to view additional sections of this Medicare policy.

--
*


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.

12/10/2024 05:20:11 18.97.14.84

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.