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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.
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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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The Venereal Disease
Research Laboratory (VDRL) test and its analogues, Rapid Plasma Reagin
(RPR) and Automated Reagin Test (ART), are the standard laboratory tests
used for syphilis screening and nonspecific confirmation of syphilitic
infection. Based on hemagglutination of sheep red blood cells, these tests
demonstrate the presence of antibodies frequently present in
syphilis-infected patients but nonspecific to syphilis confirmation of
treponemal disease (syphilis, yaws, bejel, pinta)
or false postive reactor to these reagin tests is then determined by
Treponema Pallidium Immobilization (TPI).
Medicare covered qualitative syphilis testing (e.g. VDRL. PIPR, ART) is
indicated only when there are clinical findings of the skin, eyes, teeth,
cardiovasular system, or central nervous system that suggest syphilitic
infection. Quantitative syphilis testing is indicated only when there has been previous positive results of either qualitated
or treponema pallidum confirmatory test, leg, FTA abs but is never
indicated when qualitative syphilis testing is negative. Confirmatory and
specific treponemal testing is indicated only when there has been a
previous positive test result of qualitative syphilis testing and very
rarely when clinical disease, particularly in the central nervous system,
suggests a tertiary syphilic disease of meningoencephalitis, tabes
dorsalis, or general paresis, despite a negative qualitative test for
syphilis previous positive testing at periodic intervals not to exceed
semiannually until seronegativity occurs.
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