Page 115 - Medicare Benefit Policy Manual

4. An individual with primary hyperparathyroidism.

5. An individual being monitored to assess the response to or efficacy of an FDA-
approved osteoporosis drug therapy.

80.5.7 - Noncovered BMMs
(Rev. 70, Issued: 05-11-07, Effective: 01-01-07, Implementation: 07-02-07)

The following BMMs are noncovered under Medicare because they are not considered
reasonable and necessary under section 1862(a)(1)(A) of the Act.

• Single photon absorptiometry (effective January 1, 2007).
• Dual photon absorptiometry (established in 1983).

80.5.8 - Claims Processing
(Rev. 70, Issued: 05-11-07, Effective: 01-01-07, Implementation: 07-02-07)

For instructions concerning payment methodology, HCPCS coding, and Medicare
summary notice and remittance advice messages, see chapter 13, section 140 of Pub. 100-
04, Medicare Claims Processing Manual.

80.5.9 - National Coverage Determinations (NCDs)
(Rev. 70, Issued: 05-11-07, Effective: 01-01-07, Implementation: 07-02-07)

In addition to these conditions for coverage, CMS may determine through the NCD
process that additional BMM systems are reasonable and necessary under section
1862(a)(1) of the Act for monitoring and confirming baseline BMMs.

80.6 - Requirements for Ordering and Following Orders for Diagnostic
Tests
(Rev. 80; Issued: 01-11-08; Effective: 01-01-03; Implementation: 11-19-07)

The following sections provide instructions about ordering diagnostic tests and for
complying with such orders for Medicare payment.

NOTE: Unless specified, these sections are not applicable in a hospital setting.

80.6.1 - Definitions
(Rev. 94, Issued: 08-29-08, Effective: 01-01-03, Implementation: 09-30-08)

Diagnostic Test

A “diagnostic test” includes all diagnostic x-ray tests, all diagnostic laboratory tests, and
other diagnostic tests furnished to a beneficiary.