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Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor Contractor Number: 05101 Contractor Type: MAC A

LCD Information

LCD ID Number: L35498 Status: A-Approved LCD Title: Removal of Benign Skin Lesions Geographic Jurisdiction: Iowa Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 10/26/2023 Revision End Date: CMS National Coverage Policy: CMS Pub.100-02 Medicare Benefit Policy Manual, Chapter 16 - General Exclusions From Coverage, Section §120 - Cosmetic Surgery CMS Pub. 100-03 Medicare National Coverage Determinations Manual-Chapter 1, Coverage Determinations, Part 4, Section 250.4 - Treatment of Actinic Keratosis CMS Pub.100-04 Medicare Claims Processing Manual, Ch. 23 Fee Schedule Administration and Coding Requirements, Section 10.1-10.6 - Reporting ICD Diagnosis and Procedure Codes Title XVIII of the Social Security Act, section 1862 (a)(1)(A). This section allows coverage and payment of those services that are considered to be medically reasonable and necessary. CMS Transmittal No, 863, 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. *