Printer Friendly Version

Contractor Information

Contractor Name: First Coast Service Options, Inc. - Full list of policies of this Medicare Contractor Contractor Number: 09102 Contractor Type: MAC B

LCD Information

LCD ID Number: L33907 Status: A-Approved LCD Title: Hepatic (Liver) Function Panel Geographic Jurisdiction: Florida Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 09/07/2021 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 Hepatic (Liver) Function Panel. 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/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 Hepatic (Liver) Function Panel 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.  Internet Only Manual (IOM) Citations:   CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 11, Section 20 Renal Dialysis Items and Services, Section 20.2 Laboratory Services, Section 30.1 Home Dialysis Items and Services, Section 30.2 Home Dialysis Training, Section 40 G. Renal Dialysis Services Furnished During the Creation or Revision of a Vascular Access, and Section 100.5 Renal Dialysis Services Included in the AKI Payment Rate Chapter 15, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 3, Section 190.10 Laboratory Tests - CRD Patients  CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 8, Section 50.1 Laboratory Services Included in the End Stage Renal Disease Prospective Payment System ESRD PPS,  Section 60 Separately Billable ESRD Items and Services, and Section 60.1 Lab Services Chapter 16 Laboratory Services Chapter 23, Section 40 Clinical Diagnostic Laboratory Fee Schedule  CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD  Social Security Act (Title XVIII) Standard References:   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). This section excludes routine physical examinations.  Federal Register 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 Sorry, you need to login or register to view additional sections of this Medicare policy. *