CodeMap® LCD-L39726

Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 13202
Contractor Type: MAC B

LCD Information

LCD ID Number: L39726 Status: A-Approved
LCD Title: KidneyIntelX and KidneyIntelX.dkd Testing
Geographic Jurisdiction: New York - Downstate Other Jurisdictions
Original Determination Effective Date: 08/01/2024
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Internet Only Manual (IOM) Citations:

CMS IOM Publication 100-04, Medicare Claims Processing Manual,

Chapter 1, Section 60 Provider Billing of Non-covered Charges on Institutional Claims

Chapter 16, Laboratory Services

Chapter 23, Section 20.9 National Correct Coding Initiative (NCCI), Section 20.9.1.1 Instructions for Codes with Modifiers (A/B MACs (B) Only), and Section 40 Clinical Diagnostic Laboratory Fee Schedule

CMS IOM Publication 100-08, Medicare Program Integrity Manual,

Chapter 3, Sections 3.4.1.3 Diagnosis Code Requirements and 3.6.2.3 Limitations of Liability Determinations

National Correct Coding Initiative (NCCI) Citation:

NCCI Policy Manual for Medicare Services,

Chapter 10, Pathology/Laboratory Services, (A) Introduction and (F) Molecular Pathology

Social Security Act (Title XVIII) Standard References:

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Title XVIII of the Social Security Act, Section 1834A(d) This section addresses payment for new advanced diagnostic laboratory tests.

Code of Federal Register (CFR) References:

CFR, Title 42, Volume 2, Chapter IV, Part 410.32(d)(3) Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

CFR, Title 42, Volume 3, Chapter IV, Part 414, Subpart G Payment for Clinical Diagnostic Laboratory Tests.

CFR, Title 42, Volume 3, Chapter IV, Part 414.50 Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing physician or other supplier.

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03/15/2025 06:58:16 18.97.14.83

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