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LCD ID Number
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L12873
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LCD Title
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Infrared Heating Pad Systems
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Contractor's Determination Number
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INFRED20070701
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AMA CPT / ADA CDT Copyright Statement
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CPT codes, descriptions and other data only are copyright 2006
American Medical Association (or such other date of publication of CPT).
All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental
Terminology, (CDT) (including procedure codes, nomenclature, descriptors
and other data contained therein) is copyright by the American Dental
Association. © 2002, 2004 American Dental Association. All rights reserved.
Applicable FARS/DFARS apply.
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CMS National Coverage Policy
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CMS PUB 100-3, Medicare National Coverage Determinations
Manual, Chapter 1, Section 270.6
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Primary
Geographic Jurisdiction
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Connecticut
District of Columbia
Delaware
Illinois
Indiana
Kentucky
Massachusetts
Maryland
Maine
Michigan
Minnesota
New Hampshire
New Jersey
New York - Entire State
Ohio
Pennsylvania
Rhode Island
Virginia
Vermont
Wisconsin
West Virginia
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Oversight Region
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Central Office
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DME Region LCD Covers
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Jurisdiction A/B
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Original Determination Effective Date
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For services performed on or after 10/01/2003
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Original Determination Ending Date
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Revision Effective Date
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For services performed on or after 07/01/2007
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Revision Ending Date
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Indications and Limitations of Coverage and/or Medical
Necessity
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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 medical policy, the criteria for “reasonable and necessary” are
defined by the following indications and limitations of coverage and/or
medical necessity.
For an item to be covered by Medicare, a written signed and dated order
must be received by the supplier before a claim is submitted. If the
supplier bills for an item addressed in this policy without first receiving
the completed order, the item will be denied as not medically necessary.
There are no indications for which these devices have been demonstrated to
have any therapeutic effect. The device and any related accessories will be
denied as not medically reasonable and necessary.
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Coverage Topic
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Durable Medical Equipment
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