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CodeMap® LCD-L34199

 

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L34199
LCD for Treatment of Ulcers & Symptomatic Hyperkeratoses (L34199)
See related Articles:
A57460-Billing and Coding: Treatment of Ulcers & Symptomatic Hyperkeratoses

Contractor Information

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

Contractor Number: 02401

Contractor Type: MAC A

LCD Information

LCD ID Number: L34199 Status: A-Approved

LCD Title: Treatment of Ulcers & Symptomatic Hyperkeratoses

Geographic Jurisdiction: Washington Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 10/01/2019

Revision End Date:

CMS National Coverage Policy:

Title XVIII of the Social Security Act, Section 1862 (a) (1) (A). This section allows coverage and payment only for those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, section 1833 (e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1862(a)(13) of the Act excludes payment for the treatment of flat foot conditions, the treatment of subluxation of the foot, and routine foot care (Medicare Benefit Policy Manual, Chapter 16, Section 30 and Chapter 15, Section 290).

Consultation services rendered by a podiatrist in a skilled nursing facility are covered if the services are reasonable and necessary and do not come within any of the specific statutory exclusions (NCD 70.2).

While this policy primarily addresses disease of the foot and lower extremity the policy includes skin ulcers and hyperkeratosis on other body parts.


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05/11/2021 12:13:57 3.226.72.118


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