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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: L34635 Status: A-Approved LCD Title: Botulinum Toxin Type A & Type B Geographic Jurisdiction: Nebraska Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 10/01/2023 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 IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 - Reasonable and Necessary Provisions in an LCD. Sorry, you need to login or register to view additional sections of this Medicare policy. *