CodeMap® LCD-L38571

Contractor Information

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

Contractor Number: 14312
Contractor Type: MAC B

LCD Information

LCD ID Number: L38571 Status: A-Approved
LCD Title: Colon Capsule Endoscopy (CCE)
Geographic Jurisdiction: New Hampshire 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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06/25/2025 02:12:16 18.97.14.90

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