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LCD ID Number: L34624 Status: A-Approved
LCD Title: Somatosensory Testing
Geographic Jurisdiction: Indiana Other Jurisdictions
Original Determination Effective Date:
10/01/2015
Original Determination Ending Date:
Revision Effective Date:
10/01/2023
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act (SSA):
Section 1862(a)(1)(A) 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) prohibits Medicare payment for any claim which lacks the necessary
information to process the claim.
Code of Federal Regulations:
42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific
medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).
CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2: Section 160.23 Sensory Nerve Conduction Threshold Tests (sNCTs)
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 23 - Fee Schedule Administration and Coding Requirements: Section 10 - Reporting ICD Diagnosis and Procedure Codes
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