CodeMap® LCD-L37210

Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor

Contractor Number: 05302
Contractor Type: MAC B

LCD Information

LCD ID Number: L37210 Status: A-Approved
LCD Title: MolDX: Decision Dx-UM (Uveal Melanoma)
Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions
Original Determination Effective Date: 09/16/2017
Original Determination Ending Date:
Revision Effective Date: 06/27/2024
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act (the “Act”), Section 1862(a)(1)(A) allows coverage and payment for only those services that are reasonable and necessary.

42 CFR. 410.32 Diagnostic X-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests. §80.1.1 Certification Changes.

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06/25/2025 03:31:59 18.97.14.90

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