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Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor Contractor Number: 01211 Contractor Type: MAC A

LCD Information

LCD ID Number: L35170 Status: A-Approved LCD Title: Botulinum Toxin Types A and B Policy Geographic Jurisdiction: American Samoa, Guam, Hawaii, Northern Mariana Islands Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 10/01/2019 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1862(a)(1)(A). Allows coverage and payment for only those services that are considered to be medically reasonable and necessary. Title XVIII of the Social Security Act, §1833(e). Prohibits Medicare payment for any claim, which lacks the necessary information to process the claim. CMS Manual System, Publication 100-02, Medicare Benefit Policy Manual, Chapter 16, §120. General Exclusions from Coverage (Cosmetic Surgery). Sorry, you need to login or register to view additional sections of this Medicare policy. *