Persius/hicric huggingface dataset:
Prior to August 5, l985, Medicare covered cytotoxic food tests as an adjunct
to in vivo clinical allergy tests in complex food allergy problems. Effective
August 5, l985, cytotoxic leukocyte tests for food allergies are excluded from
Medicare coverage because available evidence does not show that these tests
are safe and effective. This exclusion was published as a CMS Ruling in the
"Federal Register" on July 5, l985.
Medicare coverage of the procedure would be limited to selected patients:
those with complex ongoing acute arrhythmias, those with intermittent or
permanent heart block in whom pacemaker implantation is being considered, and
those patients who have recently developed heart block secondary to a
myocardial infarction. When heart catheterization and the HIS Bundle Study are
performed at the same time, the program will cover only one catheterization
and a small additional charge for the study.

When a HIS bundle cardiogram is obtained as part of a diagnostic endocardial
electrical stimulation, no separate charge will be recognized for the HIS
bundle study.
The use of this device is indicated where the patient exhibits clinical
symptoms or signs suggestive of endometrial disease, such as irregular or
heavy vaginal bleeding.

Program payment cannot be made for the washer or the related diagnostic
services when furnished in connection with the examination of an asymptomatic
patient. Payment for routine physical checkups is precluded under the statute.
(See 1862(a)(7) of the Act.)
Thermography for any indication (including breast lesions which were excluded
from Medicare coverage on July 20, 1984) is excluded from Medicare coverage
because the available evidence does not support this test as a useful aid in
the diagnosis or treatment of illness or injury. Therefore, it is not
considered effective. This exclusion was published as a CMS Final Notice in
the "Federal Register" on November 20, 1992.
Medicare coverage is extended to those procedures listed in Category I below
when used for the accepted medical indications mentioned above. The procedures
in Category II are still considered experimental and are not covered at this
time. Denial of claims because a noncovered procedure was used or because
there was no medical indication for plethysmographic evaluation of any type
should be based on 1862(a)(1) of the Act.

**Category I - Covered**

Segmental Plethysmography - Included under this procedure are services
performed with a regional plethysmograph, differential plethysmograph,
recording oscillometer, and a pulse volume recorder.

Electrical Impedance Plethysmography

Ultrasonic Measurement of Blood Flow (Doppler) - While not strictly a
plethysmographic method, this is also a useful tool in the evaluation of
suspected peripheral vascular disease or preoperative screening of podiatric
patients with suspected peripheral vascular compromise. (See 50-7 for the
applicable coverage policy on this procedure.)

Oculoplethysmography - See NCD on Noninvasive Tests of Carotid Function,
[20.17](https://www.cms.gov/medicare-coverage-database/details/ncd-
details.aspx?NCDId=212&ncdver=1&DocID=20.17&kq=true&SearchType=Advanced&bc=EAAAAAgAAAAA&).

Strain Gauge Plethysmography - This test is based on recording the non-
pulsatile aspects of inflowing blood at various points on an extremity by a
mercury-in-silastic strain gauge sensor. The instrument consists of a chart
recorder, an automatic cuff inflation and deflation system, and a recording
manometer.

**Category II - Experimental**

The following methods have not yet reached a level of development such as to
allow their routine use in the evaluation of suspected peripheral vascular
disease.

Inductance Plethysmography - This method is considered experimental and does
not provide reproducible results.

Capacitance Plethysmography - This method is considered experimental and does
not provide reproducible results.

Mechanical Oscillometry - This is a non-standardized method which offers poor
sensitivity and is not considered superior to the simple measurement of
peripheral blood pressure.

Photoelectric Plethysmography - This method is considered useful only in
determining whether or not a pulse is present and does not provide
reproducible measurements of blood flow.

Differential plethysmography, on the other hand, is a system which uses an
impedance technique to compare pulse pressures at various points along a limb,
with a reference pressure at the mid-brachial or wrist level. It is not clear
whether this technique, as usually performed in the physician's office, meets
the definition of plethysmography because quantitative measurements of blood
flow are usually not made. It has been concluded, in any event, that the
differential plethysmography system is a blood pulse recorder of undetermined
value, which has the potential for significant overutilization. Therefore,
reimbursement for studies done by techniques other than venous occlusive
pneumoplethysmography should be denied, at least until additional data on
these devices, including controlled clinical studies, become available.
**

Indications

**

  1. To detect viral hepatitis infection when there are abnormal liver function test results, with or without signs or symptoms of hepatitis.
  2. Prior to and subsequent to liver transplantation.

**

Limitations

**

After a hepatitis diagnosis has been established, only individual tests,
rather than the entire panel, are needed.

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).
**

Indications

**

  1. To evaluate known or suspected alimentary tract conditions that might cause bleeding into the intestinal tract.
  2. To evaluate unexpected anemia.
  3. To evaluate abnormal signs, symptoms, or complaints that might be associated with loss of blood.
  4. To evaluate patient complaints of black or red-tinged stools.

**

Limitations

**

  1. The FOBT is reported once for the testing of up to three separate specimens (comprising either one or two tests per specimen).
  2. In patients who are taking non-steroidal anti-inflammatory drugs and have a history of gastrointestinal bleeding but no other signs, symptoms, or complaints associated with gastrointestinal blood loss, testing for occult blood may generally be appropriate no more than once every three months.

When testing is done for the purpose of screening for colorectal cancer in the
absence of signs, symptoms, conditions, or complaints associated with
gastrointestinal blood loss, report the HCPCS code for colorectal cancer
screening; fecal-occult blood test, 1-3 simultaneous determinations should be
used.

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).
A white cane for use by a blind person is more an identifying and self-help
device rather than an item which makes a meaningful contribution in the
treatment of an illness or injury.
Consultation services rendered by a podiatrist in a skilled nursing facility
are covered if the services are reasonable and necessary and do not come
within any of the specific statutory exclusions. Section 1862(a)(13) of the
Act excludes payment for the treatment of flat foot conditions, the treatment
of subluxations of the foot, and routine foot care. To determine whether the
consultation comes within the foot care exclusions, apply the same rule as for
initial diagnostic examinations, i.e., where services are performed in
connection with specific symptoms or complaints which suggest the need for
covered services, the services are covered regardless of the resulting
diagnosis. The exclusion of routine physician examinations is also pertinent
and would generally exclude podiatric consultation performed on all patients
in a skilled nursing facility on a routine basis for screening purposes,
except in those cases where a specific foot ailment is involved. Section
1862(a)(7) of the Act excludes payment for routine physical checkups.
Diabetic sensory neuropathy with LOPS is a localized illness of the feet and
falls within the regulation's exception to the general exclusionary rule (see
42 CFR 411.15(l)(1)(i)). Foot exams for people with diabetic sensory
neuropathy with LOPS are reasonable and necessary to allow for early
intervention in serious complications that typically afflict diabetics with
the disease.

Effective for services furnished on or after July 1, 2002, Medicare covers, as
a physician service, an evaluation (examination and treatment) of the feet no
more often than every six months for individuals with a documented diagnosis
of diabetic sensory neuropathy and LOPS, as long as the beneficiary has not
seen a foot care specialist for some other reason in the interim. LOPS shall
be diagnosed through sensory testing with the 5.07 monofilament using
established guidelines, such as those developed by the National Institute of
Diabetes and Digestive and Kidney Diseases guidelines. Five sites should be
tested on the plantar surface of each foot, according to the National
Institute of Diabetes and Digestive and Kidney Diseases guidelines. The areas
must be tested randomly since the loss of protective sensation may be patchy
in distribution, and the patient may get clues if the test is done
rhythmically. Heavily callused areas should be avoided. As suggested by the
American Podiatric Medicine Association, an absence of sensation at two or
more sites out of 5 tested on either foot when tested with the 5.07 Semmes-
Weinstein monofilament must be present and documented to diagnose peripheral
neuropathy with loss of protective sensation.

The examination includes:

  1. A patient history, and

  2. A physical examination that must consist of at least the following elements:  
  

    * Visual inspection of forefoot and hindfoot (including toe web spaces);
    * Evaluation of protective sensation;
    * Evaluation of foot structure and biomechanics;
    * Evaluation of vascular status and skin integrity;
    * Evaluation of the need for special footwear; and

  3. Patient education.

**A. Treatment includes, but is not limited to:**

  * Local care of superficial wounds; 
  * Debridement of corns and calluses; and 
  * Trimming and debridement of nails.
Gastrophotography is an accepted procedure for diagnosis and treatment of
gastrointestinal disorders. The photographic record provided by this procedure
is often necessary for consultation and/or followup purposes and when required
for such purposes, is more valuable than a conventional gastroscopic
examination. Such a record facilitates the documentation and evaluation
(healing or worsening) of lesions such as the gastric ulcer, facilitates
consultation between physicians concerning difficult-to-interpret lesions,
provides preoperative characterization for the surgeon, and permits better
diagnosis of postoperative gastric bleeding to help determine whether there is
a need for reoperation. Therefore, program reimbursement may be made for this
procedure.
Program payment cannot be made for the aspirator or the related diagnostic
services when furnished in connection with the examination of an asymptomatic
patient. Payment for routine physical checkups is precluded under the statute
(1862(a)(7) of the Act).
**220.3- Magnetic Resonance Angiography (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.3 has been removed from the NCD Manual and _merged_
with section 220.2 _effective June 3, 2010._
Program payment may be made only for those services employing the
hemorheograph which are performed for preoperative and postoperative
diagnostic evaluation of suspected peripheral artery disease.

**NOTE:** This instrument is not a plethysmograph and is not considered as
such. A plethysmograph measures and records changes in the size of a body part
as modified by the circulation of blood in that part. The hemorheograph, on
the other hand, measures surface blood flow in the skin; it does not measure
total blood flow in a digit or limb.
Laboratory tests are essential to monitor the progress of CRD patients. The
following list and frequencies of tests constitute the level and types of
routine laboratory tests that are covered. Bills for other types of tests are
considered nonroutine. Routine tests at greater frequencies must include
medical justification. Nonroutine tests generally are justified by the
diagnosis. The routinely covered regimen includes the following tests.

Per Dialysis

  * All hematocrit or hemoglobin and clotting time tests furnished incident to dialysis treatments.

Per Week

  * Prothrombin time for patients on anticoagulant therapy
  * Serum Creatinine

Per Week or Thirteen Per Quarter

  * BUN

Monthly

  * CBC
  * Serum Calcium
  * Serum Potassium
  * Serum Chloride
  * Serum Bicarbonate
  * Serum Phosphorous
  * Total Protein
  * Serum Albumin
  * Alkaline Phospatase
  * AST, SGOT
  * LDH

Guidelines for tests other than those routinely performed include:

  * Serum Aluminum - one every 3 months
  * Serum Ferritin - one every 3 months

The following tests for hepatitis B are covered when patients first enter a
dialysis facility: Hepatitis B surface antigen (HBsAg), Anti-HBs. Coverage of
future testing in these patients depends on their serologic status and on
whether they have been successfully immunized against hepatitis B virus. The
following table summarizes the frequency of serologic surveillance for
hepatitis B. Tests furnished according to this table do not require additional
documentation and are paid separately because payment for maintenance dialysis
treatments does not take them into account.

  
Frequency of Screening  
---  
  
|  Vaccination and Serologic Status |  HBsAg Patients |  Anti-HBs Patients  
Unvaccinated |  Susceptible |  Monthly |  Semiannually  
Unvaccinated |  HBsAg Carrier |  Annually |  None  
Unvaccinated |  Anti-HBs-Positive  1 |  None |  Annually  
Vaccinated |  Anti-HBs-Positive  1 |  None |  Annually  
Vaccinted |  Low Level or No Anti-HBs |  Monthly |  Semiannually  
1 At least 10 sample ration units by radioimmunoassay or positive by enzyme
immunoassay.  
  

Patients who are in the process of receiving hepatitis B vaccines, but have
not received the complete series, should continue to be routinely screened as
susceptible. Between one and six months after the third dose, all vaccines
should be tested for anti-HBs to confirm their response to the vaccine.
Patients who have a level of anti-HBs of at least 10 sample ratio units (SRUs)
by radioimmunoassay (RIA) or who are positive by enzyme immunoassay (EIA) are
considered adequate responders to vaccine and need only be tested for anti-HBs
annually to verify their immune status. If anti-HBs drops below 10 SRUs by RIA
or is negative by EIA, a booster dose of hepatitis B vaccine should be given.

Laboratory tests are subject to the normal coverage requirements. If the
laboratory services are performed by a free-standing facility, be sure it
meets the conditions of coverage for independent laboratories.
**190.4  Electron Microscope (RETIRED)  
_(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

_

Effective December 18, 2014, NCD 190.4 is _retired._
Reasonable and necessary medical services rendered up to and including
pronouncement of death by a physician are covered diagnostic or therapeutic
services.
**CIM 50-20, CIM 50-20.1**

A diagnostic pap smear and related medically necessary services are covered
under Medicare Part B when ordered by a physician under one of the following
conditions:

  * Previous cancer of the cervix, uterus, or vagina that has been or is presently being treated;
  * Previous abnormal pap smear;
  * Any abnormal findings of the vagina, cervix, uterus, ovaries, or adnexa;
  * Any significant complaint by the patient referable to the female reproductive system; or
  * Any signs or symptoms that might in the physician's judgment reasonably be related to a gynecologic disorder.

Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical
or Vaginal Cancer. (See section [210.2](https://www.cms.gov/medicare-coverage-
database/details/ncd-details.aspx?NCDId=185&ncdver=3).)
A diagnostic mammography is a covered service if it is ordered by a doctor of
medicine or osteopathy as defined in 1861(r)(1) of the Act.

Payment may not be made for a screening mammography performed on a woman under
age 35. Payment may be made for only one screening mammography performed on a
woman over age 34, but under age 40. For an asymptomatic woman over age 39,
payment may be made for a screening mammography performed after at least 11
months have passed following the month in which the last screening mammography
was performed.

A radiological mammogram is a covered diagnostic test under the following
conditions:

  * A patient has distinct signs and symptoms for which a mammogram is indicated;
  * A patient has a history of breast cancer; or
  * A patient is asymptomatic but, on the basis of the patient's history and other factors the physician considers significant, the physician's judgment is that a mammogram is appropriate.

Use of mammograms in routine screening of: (1) asymptomatic women aged 50 and
over, and (2) asymptomatic women aged 40 or over whose mothers or sisters have
had the disease, is considered medically appropriate, but would not be covered
for Medicare purposes.
This procedure is covered when it is used on an outpatient basis if it is
reasonable and necessary for the individual patient.

Challenge ingestion food testing has not been proven to be effective in the
diagnosis of rheumatoid arthritis, depression, or respiratory disorders.
Accordingly, its use in the diagnosis of these conditions is not reasonable
and necessary within the meaning of section 1862(a)(1) of the Act, and no
program payment is made for this procedure when it is so used.
This testing is safe and effective when it is performed on patients:

_A._      In preparation for a kidney transplant;

_B._      In preparation for bone marrow transplantation;

_C._      In preparation for blood platelet transfusions (particularly where
multiple infusions are involved); or

_D._      Who are suspected of having ankylosing spondylitis.

This testing is covered under Medicare when used for any of the indications
listed in A, B, and C and if it is reasonable and necessary for the patient.

It is covered for ankylosing spondylitis in cases where other methods of
diagnosis would not be appropriate or have yielded inconclusive results.
Request documentation supporting the medical necessity of the test from the
physician in all cases where ankylosing spondylitis is indicated as the reason
for the test.
Hair analysis to detect mineral traces as an aid in diagnosing human disease
is not a covered service under Medicare.

The correlation of hair analysis to the chemical state of the whole body is
not possible at this time, and therefore this diagnostic procedure cannot be
considered to be reasonable and necessary under 1862(a)(1) of the Act.
Esophageal manometry is covered under Medicare where it is determined to be
reasonable and necessary for the individual patient.
Speech-language pathology services are covered under Medicare for the
treatment of dysphagia, regardless of the presence of a communication
disability.
Despite the "dental services exclusion" in 1862(a)(12) of the Act (see the
[Medicare Benefit Policy Manual](https://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673), Chapter
16, "General Exclusions from Coverage," 140), an oral or dental examination
performed on an inpatient basis as part of a comprehensive workup prior to
renal transplant surgery is a covered service. This is because the purpose of
the examination is not for the care of the teeth or structures directly
supporting the teeth. Rather, the examination is for the identification, prior
to a complex surgical procedure, of existing medical problems where the
increased possibility of infection would not only reduce the chances for
successful surgery but would also expose the patient to additional risks in
undergoing such surgery.

Such a dental or oral examination would be covered under Part A of the program
if performed by a dentist on the hospital's staff, or under Part B if
performed by a physician. (When performing a dental or oral examination, a
dentist is not recognized as a physician under 1861(r) of the Act.) (See the
[Medicare General Information, Eligibility, and Entitlement
Manual](https://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS050111), Chapter
5, "Definitions," 70.2, and the Medicare Benefit and Entitlement Manual,
Chapter 15, "Covered Medical and Other Health Services," 150.)
**220.7 - Xenon Scan (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Effective December 18, 2014, NCD 220.7 is _retired._
These instructions describe the application of the reasonable and necessary
payment exclusion to diagnostic procedures, such as chest x-rays, urinalysis,
etc. provided to patients upon admission to a hospital or skilled nursing
facility.

The major factors which support a determination that a diagnostic procedure
performed as part of the admitting procedure to a hospital or skilled nursing
facility is reasonable and necessary, are:

  1. The test is specifically ordered by the admitting physician (or a hospital or skilled nursing facility staff physician having responsibility for the patient where there is no admitting physician): i.e., it is not furnished under the standing orders of a physician for his patients; 
  2. The test is medically necessary for the diagnosis or treatment of the individual patients condition; and
  3. The test does not unnecessarily duplicate the same test performed on an outpatient basis prior to admission or performed in connection with a recent hospital or skilled nursing facility admission.

Where the Medicare Administrative Contractor has not already done so, consult
with the Quality Improvement Organizations (QIOs) to obtain information
gathered by the QIOs on a sample basis as to whether x-rays and diagnostic
tests are being specifically ordered as described under subsection (A).
Based upon advice of our medical consultants, we have determined that the
Peridex CAPD Filter Set cannot be covered at this time by Medicare because it
has not yet been shown to be safe and effective in preventing peritonitis.
Medicare covers these tests when they are reasonable and necessary for the
diagnosis or treatment of the following conditions:

  * Genetic disorders (e.g., mongolism) in a fetus; (See the Medicare Benefit Policy Chapter 15, "Covered Medical and Other Health Services," 20.1)
  * Failure of sexual development;
  * Chronic myelogenous leukemia;
  * Acute leukemias lymphoid (FAB L1-L3), myeloid (FAB M0-M7), and unclassified; or
  * Mylodysplasia
**220.8 - Nuclear Radiology Procedure (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Effective December 18, 2014, NCD 220.8 is _retired._
Evoked response tests, including brain stem evoked response and visual evoked
response tests, are generally accepted as safe and effective diagnostic tools.
Program payment may be made for these procedures.
Uroflowmetric evaluations (also referred to as urodynamic voiding or
urodynamic flow studies) are covered under Medicare for diagnosing various
urological dysfunctions, including bladder outlet obstructions.
Covered

Ultrafiltration and ultrafiltration monitoring as a component of hemodialysis
has an established and critical role in maintaining the well-being of ESRD
patients and is a covered service. The Ultrafiltration Monitor is covered
under the Medicare program when it is used to calculate fluid rates for those
recipients who present difficult fluid management problems. Determine the
medical necessity of this device on a case-by-case basis.

Not Covered

Ultrafiltration, independent of conventional dialysis, is considered
experimental, and technology exclusively designed for this purpose is not
covered under Medicare.