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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 11502 Contractor Type: MAC B

LCD Information

LCD ID Number: L35677 Status: A-Approved LCD Title: Infliximab Geographic Jurisdiction: North Carolina Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 08/08/2024 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act 1862(a)(1)(A) allows coverage and payment for only those services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 1, §30 Drugs and Biologicals, §30.1 Drugs Included in the Drug Compendia, §30.2 Approval by Pharmacy and Drug Therapeutics Committee, §30.3 Combination Drugs, §30.4 Drugs Specially Ordered for Inpatients, §30.5 Drugs for Use Outside the Hospital CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §50 Drugs and Biologicals, §50.1 Definition of Drug or Biological, §50.4.1 Approved Use of Drug, §50.4.2 Unlabeled Use of Drug, §50.4.3 Examples of Not Reasonable and Necessary, §50.4.5 Off-Label Use of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic Regimen Sorry, you need to login or register to view additional sections of this Medicare policy. *