Coverage Determinations
Medicare Medical Necessity Local Coverage Determinations: Medical necessity is the measure of whether a healthcare procedure or service is appropriate for the diagnosis and/or treatment of a condition. LCDs, or local coverage determinations, specify under what clinical circumstances a service is covered.
Access https://www.cms.gov/medicare-
Locate and present three procedures/services to determine whether Medicare covers that procedure or service, by scrolling down and clicking on the blue ID to select the procedure (L32553) (the first time might include a License Agreement, go to bottom right and agree, otherwise, when you click the code the information on it will open
Provide details on why or why not this procedure or service is covered. Scroll through the coverage, the outline will provide details on coverage, limitations, and stipulations. As you review details of coverage note the ICD-10 codes which are deemed medically necessary in support of this procedure.
What if any stipulations exist of covering these services or procedures?
