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Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor Contractor Number: 08202 Contractor Type: MAC B

LCD Information

LCD ID Number: L35494 Status: A-Approved LCD Title: Mohs Micrographic Surgery Geographic Jurisdiction: Michigan Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 12/31/2020 Revision End Date: CMS National Coverage Policy: Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording. Title XVIII of the Social Security Act (SSA) Title XVIII of the Social Security Act, Sections 1861 [s] [1], only physicians (MD/DO) may perform this procedure. Title XVIII of the Social Security Act, Section 1862 (a) (1)(A), this section allows coverage and payment for only those services considered medically reasonable and necessary. 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, Section §30 - Physician Services. CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16 – General Exclusions From Coverage, Section §120 - Cosmetic Surgery. CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12 – Physicians/Nonphysician Practitioners, Section §40-40.6, Surgeons and Global Surgery. CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12 – Physicians/Nonphysician Practitioners, Section §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. 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. 08/08/2022 02:20:04 18.204.56.185