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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: L38765 Status: A-Approved LCD Title: Facet Joint Interventions for Pain Management Geographic Jurisdiction: Georgia Other Jurisdictions Original Determination Effective Date: 04/25/2021 Original Determination Ending Date: Revision Effective Date: 07/07/2024 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1861(s)(2) addresses medical and other health services. 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) excludes routine physical examinations. Title XVIII of the Social Security Act, §1862(a)(14) defines other than physician services. 42 CFR §410.74 defines physician assistants' services, §410.75 defines nurse practitioners' services, §410.76 defines clinical nurse specialists' services, and §419.22 defines hospital services excluded from payment under the hospital outpatient prospective payment system. CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §50 Drugs and Biologicals CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1, §30.3 Acupuncture; Part 2, §150.7 Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents; and Part 4, §220.1 Computed Tomography (CT) CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.4 Reasonable and Necessary Provisions in LCDs Sorry, you need to login or register to view additional sections of this Medicare policy. *