History/Background and/or General Information
Title XVIII of the Social Security Act, Section 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.Social Security Act (Title XVIII) Standard References: Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD.CMS IOM Publication 100-08, Medicare Program Integrity Manual,.Chapter 23, Section 20.9 National Correct Coding Initiative (CCI).CMS IOM Publication 100-04, Medicare Claims Processing Manual,.Chapter 1, Part 2, Section 160.2 Treatment of Motor Function Disorders with Electric Nerve Stimulation, Section 160.7 Electrical Nerve Stimulators.CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual,.Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for Spinal Cord Stimulation for Chronic Pain and must properly submit only valid claims for them. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Spinal Cord Stimulation for Chronic Pain. Not endorsed by the AHA or any of its affiliates. Presented in the material do not necessarily represent the views of the AHA. Preparation of this material, or the analysis of information provided in the material. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness orĪccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Resale and/or to be used in any product or publication creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions Īnd/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyĪuthorized with an express license from the American Hospital Association. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. AHA copyrighted materials including the UB‐04 codes andĭescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may beĬopied without the express written consent of the AHA.
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