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Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor Contractor Number: 03102 Contractor Type: MAC B

LCD Information

LCD ID Number: L36286 Status: A-Approved LCD Title: Blepharoplasty, Eyelid Surgery, and Brow Lift Geographic Jurisdiction: Arizona Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 10/01/2019 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. Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim, which lacks the necessary information to process the claim. Title XVIII of the Social Security Act, §1862(a)(10), prohibits payment for cosmetic surgery; procedures performed only to approve appearances without a functional benefit are not covered by Medicare, except as required for the prompt repair of accidental injury or for improvement of the functioning of a malformed body member. CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16, §20, Services not reasonable and necessary. CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16, §120, Cosmetic Surgery. Sorry, you need to login or register to view additional sections of this Medicare policy. *