CodeMap® LCD-L39644

Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor

Contractor Number: 02302
Contractor Type: MAC B

LCD Information

LCD ID Number: L39644 Status: A-Approved
LCD Title: Intraosseous Basivertebral Nerve Ablation
Geographic Jurisdiction: Oregon Other Jurisdictions
Original Determination Effective Date: 01/28/2024
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Section 1862(a)(1)(A) of Title XVIII of the Social Security Act excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) of Title XVIII of the Social Security Act prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Manual System. Publication 100-2, Medicare Benefit Policy Manual, Chapter 15, §80 describes coverage for physician supervision of diagnostic x-ray, lab and other diagnostic tests.

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04/22/2025 07:33:38 18.97.14.82

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