LCD ID Number: L38775 Status: A-Approved
LCD Title: Extracorporeal Shock Wave Therapy (ESWT)
Geographic Jurisdiction: Alabama Other Jurisdictions
Original Determination Effective Date:
02/14/2021
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)(1)(D) addresses services that are determined to be investigational or experimental
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 411.15(k) excludes particular services from coverage
CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.4 Reasonable and Necessary Provisions in LCDs
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