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CodeMap® LCD-L38686

 

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L38686
LCD for Implantable Continuous Glucose Monitors (I-CGM) (L38686)
See related Articles:
A56902-Billing and Coding: Category III Codes
A58212-Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)
A58213-Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)
A58396-Response to Comments: Implantable Continuous Glucose Monitors (I-CGM) DL38686

Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor

Contractor Number: 05201

Contractor Type: MAC A

LCD Information

LCD ID Number: L38686 Status: A-Approved

LCD Title: Implantable Continuous Glucose Monitors (I-CGM)

Geographic Jurisdiction: Kansas Other Jurisdictions

Original Determination Effective Date: 10/11/2020

Original Determination Ending Date:

Revision Effective Date:

Revision End Date:

CMS National Coverage Policy:

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Implantable Continuous Glucose Monitors (I-CGM). Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for Implantable Continuous Glucose Monitors (I-CGM) and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:

IOM Citations:

  • CMS IOM 100-08, Medicare Program Integrity Manual,
    • Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
  • Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.


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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.

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06/22/2021 06:16:50 3.235.184.215


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