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2021 Regulatory Update: Hospital Outreach Programs

CodeMap® LCD-L34648

 

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L34648
LCD for Bisphosphonate Drug Therapy (L34648)
See related Articles:
A56907-Billing and Coding: Bisphosphonate Drug Therapy

Contractor Information

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

Contractor Number: 05201

Contractor Type: MAC A

LCD Information

LCD ID Number: L34648 Status: A-Approved

LCD Title: Bisphosphonate Drug Therapy

Geographic Jurisdiction: Kansas Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 08/27/2020

Revision End Date:

CMS National Coverage Policy:

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.

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. This Act requires that drugs must be reasonable and necessary in order to be covered by Medicare. This means, in the case of drugs, the FDA must approve them for marketing.

Title XVIII of the Social Security Act section 1862 (a)(1)(B) and 1862 (a)(1)(P). In the case of items and services described in section 1861(s)(10) and 1861 (ddd)(1), which relate to preventive services.

Title XVIII of the Social Security Act section 1862 (a) (1) (D). This section states that no Medicare payment may be made under part A or part B for any expenses incurred for items or services that are investigational or experimental.

Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical examinations and services.

CMS Pub 100-02 Medicare Benefit Policy Manual - Chapter 15 – Covered Medical and Other Health Services, Section
50 – Drugs and Biological, and
60 – Services and Supplies.

CMS Pub. 100-04 Medicare Claims Processing Manual, Chapter 17- Drugs and Biologicals, Section 10- Payment Rules for Drugs and Biologicals, and
Chapter 12 – Physicians/Nonphysician Practitioners, Section 30.5 –Payment for Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions.

CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 - Reasonable and Necessary Provisions in an LCD.


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06/22/2021 07:41:57 3.235.184.215


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