150 North Wacker Drive
Suite 1870
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax

2022 Printed Publications Early Bird Sale on Now through August 31, 2021!

User Information

Create New Account

Lost Password


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule

2020 (July)

Physician Fee Schedule


OPPS Fee Schedule


ASC Fee Schedule


APC Codes


DRG Codes


ASP Drug Pricing Files

April 2021
January 2021

CMS Transmittals

CodeMap® LCD-L38747


Printer Friendly Version

LCD for Peroral Endoscopic Myotomy (POEM) (L38747)
See related Articles:
A58287-Billing and Coding: Peroral Endoscopic Myotomy (POEM)
A58561-Response to Comments: Peroral Endoscopic Myotomy (POEM)

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11302

Contractor Type: MAC B

LCD Information

LCD ID Number: L38747 Status: A-Approved

LCD Title: Peroral Endoscopic Myotomy (POEM)

Geographic Jurisdiction: Virginia Other Jurisdictions

Original Determination Effective Date: 02/28/2021

Original Determination Ending Date:

Revision Effective Date:

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)(7) states Medicare will not cover any services or procedures associated with routine physical checkups

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)

42 CFR §416.65 Covered surgical procedures

Sorry, you need to login or register to view additional sections of this Medicare policy.

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.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.

08/05/2021 02:19:37

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.