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CodeMap® LCD-L38551


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LCD for Transanal Endoscopic Surgery (TES) (L38551)
See related Articles:
A58000-Billing and Coding: Transanal Endoscopic Surgery (TES)
A58300-Response to Comments: Transanal Endoscopic Surgery (TES)

Contractor Information

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

Contractor Number: 11401

Contractor Type: MAC A

LCD Information

LCD ID Number: L38551 Status: A-Approved

LCD Title: Transanal Endoscopic Surgery (TES)

Geographic Jurisdiction: West Virginia Other Jurisdictions

Original Determination Effective Date: 10/11/2020

Original Determination Ending Date:

Revision Effective Date: 05/26/2022

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.

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04/17/2024 11:20:55

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