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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