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CodeMap® LCD-L38615


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LCD for Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease (L38615)
See related Articles:
A58097-Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
A59212-Response to Comments: Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease

Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor

Contractor Number: 03302

Contractor Type: MAC B

LCD Information

LCD ID Number: L38615 Status: A-Approved

LCD Title: Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease

Geographic Jurisdiction: North Dakota Other Jurisdictions

Original Determination Effective Date: 04/26/2021

Original Determination Ending Date:

Revision Effective Date: 09/18/2022

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.

Title XVIII of the Social Security Act, §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

42 CFR §410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).

CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §220.

The Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), established a new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries.

42 CFR §414.92 codifies the Appropriate use Criteria Program policies.

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07/17/2024 09:08:34

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