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CodeMap® LCD-L38707

 

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L38707
LCD for Transurethral Waterjet Ablation of the Prostate (L38707)
See related Articles:
A58229-Billing and Coding: Transurethral Waterjet Ablation of the Prostate
A58523-Response to Comments: Transurethral Waterjet Ablation of the Prostate

Contractor Information

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

Contractor Number: 02401

Contractor Type: MAC A

LCD Information

LCD ID Number: L38707 Status: A-Approved

LCD Title: Transurethral Waterjet Ablation of the Prostate

Geographic Jurisdiction: Washington Other Jurisdictions

Original Determination Effective Date: 12/27/2020

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 Transurethral Waterjet Ablation of the Prostate. 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 Transurethral Waterjet Ablation of the Prostate 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 Publication 100-02, Medicare Benefit Policy Manual,
  • Chapter 14, Section 10 Coverage of Medical Devices
  • CMS IOM Publication 100-04, Medicare Claims Processing Manual,
    • Chapter 23, Section 30 Services paid under the Medicare Physicians Fee Schedule
  • CMS IOM Publication 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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05/10/2021 11:31:07 3.226.72.118


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