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Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor Contractor Number: 14512 Contractor Type: MAC B

LCD Information

LCD ID Number: L33394 Status: A-Approved LCD Title: Drugs and Biologicals, Coverage of, for Label and Off-Label Uses Geographic Jurisdiction: Vermont Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 08/01/2024 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 Sorry, you need to login or register to view additional sections of this Medicare policy. *