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CMS National Coverage Policy
CMS Pub. 100-3, Medicare National Coverage Determinations Manual,
Chapter 1, Section 280.4
Indications and Limitations of Coverage and/or Medical Necessity
For the items addressed in this medical policy, the criteria for
"reasonable and necessary" are defined by the following indications
and limitations of coverage and/or medical necessity.For any item to
be covered by Medicare, it must 1) be eligible for a defined Medicare
benefit category, 2) be reasonable and necessary for the diagnosis or
treatment of illness or injury or to improve the functioning of a
malformed body member, and 3) meet all other applicable Medicare
statutory and regulatory requirements. For the items addressed in this
local coverage determination, the criteria for "reasonable and
necessary", based on Social Security Act § 1862(a)(1)(A) provisions,
are defined by the following indications and limitations of coverage
and/or medical necessity
For an item addressed in this policy to be covered by Medicare, a written signed and dated order must be received by the supplier prior to delivery of the item. If the supplier delivers the item prior to receipt of a written order, it will be denied as noncovered. If the written order is not obtained prior to delivery, payment will not be made for that item even if a written order is subsequently obtained. If a similar item is subsequently provided by an unrelated supplier who has obtained a written order prior to delivery, it will be eligible for coverage. A seat lift mechanism is covered if all of the following criteria are met:
Download CMN - Requirement for Medicare Billing - Your Doctor has to
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This category has the following 22 subcategories, out of 22 total.
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