National coverage determination manual

C. External Requests for National Coverage Determinations 1. Request by an External Party for a New National Coverage Determination. Typically, a requester is a Medicare beneficiary, a manufacturer, a physician or a physician professional association. A request may be to establish, limit, or entirely remove coverage. The CMS Internet Only Manual Publication 100-3, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Section 280.1 provides a list of items that are noncovered with the reason for denial. The following items will be denied as noncovered when submitted to the DME MAC. Diagnostic Laboratory Services Quick Links: DLS Locations. Oahu; Big Island; Kauai; Maui; Molokai; Guam; Saipan Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM) *January 2017 Changes ICD-10-CM Version - Red NCD 190.31 Fu Associates, Ltd. January 2017 1773 Code Description *R97.20 *Elevated prostate specific antigen [PSA] *R97.21 *Rising PSA following treatment for malignant neoplasm of prostate Durable Medical Equipment Reference List (NCD 280.1) Page 1 of 20 (where appropriate) to all DME National Coverage Determinations (NCDs) discussed in the DME or cross-refers to another section of the manual where the applicable coverage criteria are when there is no National Coverage Determination (NCD) or when there is a need to further define an NCD. The guidelines for LCD development are provided in . Chapter 13 of the Medicare Program Integrity Manual. What's the difference between an LCD (local coverage determination) and an LMRP (local medical review policy)? Refer to National Coverage Determination Manual Section 220.6 in its entirety for specific coverage language and limitations for each indication. 2 Non-covered nationally based on evidence of harm or no benefit. 3 Covered only in specific settings discussed above if certain patient safeguards are provided. Medicare National Coverage Determinations (NCD) Coding