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October 2023
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CMS Transmittals

CodeMap® LCD-L33793


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LCD for Refractive Lenses (L33793)
See related Articles:
A52499-Refractive Lenses - Policy Article
A55426-Standard Documentation Requirements for All Claims Submitted to DME MACs

Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor

Contractor Number: 19003

Contractor Type: DME MAC

LCD Information

LCD ID Number: L33793 Status: A-Approved

LCD Title: Refractive Lenses

Geographic Jurisdiction: Alaska, American Samoa, Arizona, California - Entire State, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri - Entire State, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 10/01/2020

Revision End Date:

CMS National Coverage Policy: None

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12/10/2023 07:37:26

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