LCD ID Number: L39248 Status: P-
LCD Title: Upper Gastrointestinal Endoscopy and Visualization
Geographic Jurisdiction: South Carolina Other Jurisdictions
Original Determination Effective Date:
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) excludes routine physical examinations
42 CFR 410.32(a) indicates that diagnostic tests may only be ordered by a treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements)
CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, §100.2 Endoscopy, §100.4 Esophageal Manometry and §100.10 Injection Sclerotherapy for Esophageal Variceal Bleeding
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12/01/2022 03:03:24 18.104.22.168