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January 2023
October 2022

CMS Transmittals

In Memoriam: Gregory B. Root

CodeMap® LCD-L35170


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LCD for Botulinum Toxin Types A and B Policy (L35170)
See related Articles:
A55383-Response to Comments: Botulinum Toxin Types A and B
A57185-Billing and Coding: Botulinum Toxin Types A and B Policy

Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor

Contractor Number: 01212

Contractor Type: MAC B

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).

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03/27/2023 05:18:59

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