Computed Tomography (CT) Scans
Per Medicare’s National Coverage Determination (NCD), NCD 220.1, CT scans must be medically appropriate considering the patient’s symptoms and preliminary diagnosis. Local Coverage Determinations (LCDs) for CT scans further define the circumstances demonstrating medical necessity.
Documentation must be available to Medicare upon request. CT scans had an improper payment rate of 16 percent during the most recent reporting period for the Comprehensive Error Rate Testing (CERT) program. For more information, please refer to the Medicare Learning Network® (MLN) fact sheet Provider Compliance Tips for Computed Tomography (CT Scans) (PDF) .