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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: L35222 Status: A-Approved LCD Title: Nerve Blocks for Peripheral Neuropathy Geographic Jurisdiction: Nebraska Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 11/30/2023 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1862(a)(1)(A) This section allowed 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) The section prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Title XVIII of the Social Security Act, §1862 (a) (7). This section excludes routine physical examinations and services. CMS Pub 100-03 Medicare National Coverage Determinations (NCD) Manual Chapter - 1 Sections: 30.3 – Acupuncture 150.7 - Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents 150.6 -Vitamin B12 Injections to Strengthen Tendons, Ligaments, etc., of the Foot Sorry, you need to login or register to view additional sections of this Medicare policy. *