LCD ID Number: L38551 Status: A-Approved
LCD Title: Transanal Endoscopic Surgery (TES)
Geographic Jurisdiction: South Carolina Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
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)(1)(D) Items and services related to research and experimentation.
Title XVIII of the Social Security Act, §1862 (a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups.
42 CFR §410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions
42 CFR §414.92 Electronic Prescibing Incentive Program
CMS Internet-Only Manual, Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §220 Radiology
The Protecting Access to Medicare Act (PAMA) of 2014, §218(b), Program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries.
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.
12/01/2022 12:59:52 188.8.131.52