CodeMap® LCD-L38747

Contractor Information

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

Contractor Number: 10211
Contractor Type: MAC A

LCD Information

LCD ID Number: L38747 Status: A-Approved
LCD Title: Peroral Endoscopic Myotomy (POEM)
Geographic Jurisdiction: Georgia Other Jurisdictions
Original Determination Effective Date: 02/28/2021
Original Determination Ending Date:
Revision Effective Date: 09/12/2024
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.

12/10/2024 05:47:29 18.97.14.84

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