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LCD ID Number: L39713 Status: A-Approved
LCD Title: Trigger Point Injections
Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions
Original Determination Effective Date:
04/01/2024
Original Determination Ending Date:
Revision Effective Date:
04/01/2024
Revision End Date:
CMS National Coverage Policy:
Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording.
Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Title XVIII of the Social Security Act, §1862(a)(1)(D) Investigational or Experimental
IOM Citations:
- CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.4 Reasonable and Necessary Provision in an LCD
Social Security Act (Title XVIII) Standard References:
- Title XVIII of the Social Security Act, §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, §1862(a)(7). This section excludes routine physical examinations.
- Title XVIII of the Social Security Act, Section 1833(e) of the Social Security Act prevents Medicare from paying for services unless necessary and sufficient information is submitted that shows that services were provided and to determine the amounts due.
Code of Federal Regulations (CFR) References:
CFR, Title 42, Ch. IV, § 410.74 Physician assistants’ services, §410.75 Nurse practitioners’ services and § 410.76 Clinical nurse specialists’ services.
NCDs
NCD 30.3.3 Acupuncture for Chronic Low Back Pain
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