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LCD ID Number: L35494 Status: A-Approved
LCD Title: Mohs Micrographic Surgery
Geographic Jurisdiction: Nebraska Other Jurisdictions
Original Determination Effective Date:
10/01/2015
Original Determination Ending Date:
Revision Effective Date:
12/01/2022
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act (SSA)
- Title XVIII of the Social Security Act, §1861[s] [1], only physicians (MD/DO) may perform this procedure.
- Title XVIII of the Social Security Act, §1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
- 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.
CMS Publications
- CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, §30 - Physician Services.
- CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16 – General Exclusions From Coverage, §120 - Cosmetic Surgery.
- CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12 – Physicians/Nonphysician Practitioners, §40-40.6, Surgeons and Global Surgery.
- CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12 – Physicians/Nonphysician Practitioners, §60, Payment for Pathology Services.
- CMS Transmittal No. 434, Pub. 100-04, Medicare Claims Processing Manual, Change Request #3458, January 14, 2005, Addition of CLIA Edits to Certain Health Care Procedure Coding System (HCPCS) Codes for Mohs Surgery.
- CMS Transmittal No, 857, effective date October 3, 2018 Change Request 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019.
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