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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 11202 Contractor Type: MAC B

LCD Information

LCD ID Number: L39773 Status: A-Approved LCD Title: Cervical Fusion Geographic Jurisdiction: South Carolina Other Jurisdictions Original Determination Effective Date: 07/14/2024 Original Determination Ending Date: Revision Effective Date: 01/16/2025 Revision End Date: CMS National Coverage Policy: This LCD supplements but does not replace, modify, or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for cervical fusion procedures for pain management. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify, or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and 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 EPIDURAL procedures for pain management and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site: CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.4 Reasonable and Necessary Provision in an LCD Title XVIII of the Social Security Act, Section 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, Section 1862(a)(7) excludes routine physical examinations. 42 CFR §410.74 defines Physician assistants’ services, §410.75 defines Nurse practitioners’ services and §410.76 defines Clinical nurse specialists’ services. Sorry, you need to login or register to view additional sections of this Medicare policy. *