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CodeMap® LCD-L38571


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LCD for Colon Capsule Endoscopy (CCE) (L38571)
See related Articles:
A58294-Billing and Coding: Colon Capsule Endoscopy (CCE)
A58959-Response to Comments: Colon Capsule Endoscopy (CCE)

Contractor Information

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

Contractor Number: 14111

Contractor Type: MAC A

LCD Information

LCD ID Number: L38571 Status: A-Approved

LCD Title: Colon Capsule Endoscopy (CCE)

Geographic Jurisdiction: Maine Other Jurisdictions

Original Determination Effective Date: 04/15/2021

Original Determination Ending Date:

Revision Effective Date: 02/15/2022

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.

Code of Federal Regulations:

42 CFR 410.32 indicates that diagnostic tests may only be ordered by a treating physician (or other treating practitioner acting within the scope of their 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 100-04, Medicare Claims Processing Manual, Chapter 23: 10.1 - 10.1.7 ICD-10-CM Coding for Diagnostic Tests.

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06/07/2023 02:00:43

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