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Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor Contractor Number: 05401 Contractor Type: MAC A

LCD Information

LCD ID Number: L34596 Status: A-Approved LCD Title: Immunizations Geographic Jurisdiction: Nebraska Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 10/26/2023 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 of those services that are considered to be medically reasonable and necessary. Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical examinations and services. 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. CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, Section 50.4.4.2 - Immunizations. CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 16 - General Exclusions from Coverage, Section 90 – Routine Services and Appliances. CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 17 – Drugs and Biologicals, Section 40 – Discarded Drugs and Biologicals. CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 18 - Preventive and Screening Services, Section 1- Medicare Preventive and Screening Services and Section 10 – Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines. CMS Transmittal No. 4292, Pub 100-04, Medicare Claims Processing Manual, Change Request #11293, May 3, 2019. Quarterly Update to the Medicare Physician Fee Schedule Database-July 2019 Update. CMS Transmittal No, 857, effective date October 3, 2018 Change Request 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019. Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording. Sorry, you need to login or register to view additional sections of this Medicare policy. *