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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: L34648 Status: A-Approved LCD Title: Bisphosphonate Drug Therapy Geographic Jurisdiction: Nebraska Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 02/11/2024 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 (1) (5) (D). 21st Century Cures Act of 2016 (Public Law 114-255)- The 21st Century Cures Act of 2016 added language to section 1862(l)(5)(D) of the Social Security Act (the Act) directing the Secretary of the Department of Health and Human Services (DHHS) to improve the transparency of the LCD process. 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. Sorry, you need to login or register to view additional sections of this Medicare policy. *