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LCD
ID Number
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L1594
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LCD
Title
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Pulmonary Perfusion
Imaging
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Contractor's
Determination Number
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1594
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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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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.
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Primary Geographic
Jurisdiction
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New
Jersey
Tennessee
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Secondary Geographic
Jurisdiction
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Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
North Carolina
North Dakota
Nebraska
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
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Oversight
Region
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Region IV
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Original
Determination Effective Date
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For services performed
on or after 12/27/1996
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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 08/06/2005
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Revision
Ending Date
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Indications
and Limitations of Coverage and/or Medical Necessity
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Test to assess
ventilation perfusion patterns
Clinically indicated for: Determination of arterial perfusion of the lungs,
detection of pulmonary emboli, evaluation, preoperatively of the pulmonary
function of a patient with marginal lung reserves; for example, when a
physician is removing a portion of the lung and he/she needs to verify the
perfusion status of the opposite lung to see if the patient could survive
the surgery.
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Coverage
Topic
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Diagnostic Tests and
X-Rays
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