CodeMap® LCD-L34526

Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor

Contractor Number: 05101
Contractor Type: MAC A

LCD Information

LCD ID Number: L34526 Status: A-Approved
LCD Title: Surgical Treatment of Obstructive Sleep Apnea (OSA)
Geographic Jurisdiction: Iowa Other Jurisdictions
Original Determination Effective Date: 10/01/2015
Original Determination Ending Date:
Revision Effective Date: 07/27/2023
Revision End Date:
CMS National Coverage Policy:
CMS Pub. 100-02 Medicare Benefit Policy Manual Chapter 15 §70- Sleep Disorder Clinics;
Chapter 16 §140 Dental Services Exclusion

CMS Pub. 100-03 Medicare National Coverage Determinations Manual Chapter 1, Part 4 §240.4 Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)

Social Security Act 1862 (a)(1)(A) Medically Reasonable & Necessary.

Social Security Act 1862 (a)(1)(D) Investigational or Experimental.

CMS Transmittal No, 857, effective date October 3, 2018 Change Request 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019.

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