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LCD ID Number: L39553 Status: A-Approved
LCD Title: Radiation Therapies
Geographic Jurisdiction: South Carolina Other Jurisdictions
Original Determination Effective Date:
12/03/2023
Original Determination Ending Date:
Revision Effective Date:
03/23/2025
Revision End Date:
CMS National Coverage Policy:
This local coverage determination (LCD) supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for the referenced radiation therapies. Medicare payment policy rules and this LCD do not replace, modify or supersede applicable state statutes regarding medical (or other health practice profession) practice acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for these referenced radiation therapy (RT) procedures and must properly submit only valid claims for them. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site.
Title XVIII of the Social Security Act, §1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations.
42 CFR §410.32(b)(3) defines the levels of physician supervision for diagnostic tests.
42 CFR §410.32(b)(3)(ii) direct supervision means physical presence in the office suite in non-hospital locations; immediately available in other outpatient diagnostic services.
CMS Internet-Only Manual, Pub.100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.4 Reasonable and Necessary Provision in an LCD
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