|
CPT codes,
descriptions and other data only are copyright 2007 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.
|
|
Title XVIII of the
Social Security Act, Section 1862 (a)(1)(A). This
section excludes coverage of items or services that are not reasonable and
necessary for the diagnosis or treatment of illness or injury or to improve
the functioning of a malformed body member.
Title XVIII of the Social Security Act, Section 1862 (a)(7).
This section prohibits Medicare payment for any expenses on items and
services incurred for routine physical examinations.
Title XVIII of the Social Security Act, Section 1833 (e). This section
prohibits Medicare payment for any claim that lacks the necessary
information to process the claim.
Section 4104 of the 1997 Balanced Budget Act
HCFA Pub. 60AB Rev. AB-97-24
|
|
This policy represents
Riverbend's implementation of the National Coverage Decision (NCD) on Fecal
Occult Blood Tests and of Medicare Coverage of Colorectal Cancer Screening
Tests.
Blood, occult; feces screening, 1-3 simultaneous determinations. Occult
blood tests are performed to detect GI bleeding and for the early detection
of colorectal cancer.
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 test per specimen.)
2. In patients who are taking non-steroidal anti-inflammatory drugs and
have a history of gastrointestinal bleeding by 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.
3. 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, The HCPCS code for Colorectal cancer
screening; fecal-occult blood test, (1-3 simultaneous determinations)
should be used. Coverage of colorectal cancer screening is described in CMS
Transmittal 1062, CR 5292, November 22, 2006.
Other Comments
1. Screening fecal-occult blood tests are covered at a frequency of once
every 12 months for beneficiaries who have attained age 50 (i.e., at least
11 months have passed following the month in which the last covered
screening fecal-occult blood test was done.) Screening fecal-occult blood
test means a guaiac-based test for peroxidase activity, or an immunoassay-based test in
which the beneficiary completes it by taking samples from two different
sites of three consecutive stools. This screening requires a written order
from the beneficiary's attending physician. (The term "attending physician"
is defined to mean a doctor of medicine or osteopathy (as defined in
§1861(r)(l) of the Act) who is fully knowledgeable about the beneficiary’s
medical condition, and who would be responsible for using the results of
any examination performed in the overall management of the beneficiary’s
specific medical problem.)
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.
|