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CodeMap® LCD-L35494

 

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L35494
LCD for Mohs Micrographic Surgery (L35494)
See related Articles:
A57477-Billing and Coding: Mohs Micrographic Surgery

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.


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08/08/2022 02:20:04 18.204.56.185


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