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Important Notice: Change of Address

CodeMap® LCD-L33394


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LCD for Drugs and Biologicals, Coverage of, for Label and Off-Label Uses (L33394)
See related Articles:
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A52371-Billing and Coding: Bortezomib
A52399-Billing and Coding: Denosumab (Prolia ™, Xgeva ™)
A52408-Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars
A52420-Billing and Coding: Hyaluronans Intra-articular Injections of
A52421-Billing and Coding: Ibandronate Sodium
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A52446-Billing and Coding: Intravenous Immune Globulin (IVIG)
A52448-Billing and Coding: Omalizumab
A52450-Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
A52451-Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Brolucizumab-dbll and Faricimab-svoa
A52452-Billing and Coding: Rituximab, biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™)
A52453-Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
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A54548-Billing and Coding: Eculizumab
A54862-Billing and Coding: Nivolumab
A59216-Response to Comments: Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 06101

Contractor Type: MAC A

LCD Information

LCD ID Number: L33394 Status: A-Approved

LCD Title: Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

Geographic Jurisdiction: Illinois Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 11/01/2022

Revision End Date:

CMS National Coverage Policy:

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Publications

CMS Publication Pub 100-02, Medicare Benefit Policy Manual, Chapter 15:

    50 - Drugs and Biologicals
    50.4.5 - Off-Label Use of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic Regimen

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 17:

    10 - Payment Rules for Drugs and Biologicals

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All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

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06/07/2023 02:50:53

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