150 North Wacker Drive
Suite 1870
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax

User Information

Create New Account

Lost Password


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule


Physician Fee Schedule


OPPS Fee Schedule


ASC Fee Schedule


APC Codes


DRG Codes


ASP Drug Pricing Files

October 2022
July 2022

CMS Transmittals

CodeMap® LCD-L34648


Printer Friendly Version

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: 08102

Contractor Type: MAC B

LCD Information

LCD ID Number: L34648 Status: A-Approved

LCD Title: Bisphosphonate Drug Therapy

Geographic Jurisdiction: Indiana 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.

Sorry, you need to login or register to view additional sections of this Medicare policy.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.

12/01/2022 02:59:20

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.