LCD ID Number: L36286 Status: A-Approved
LCD Title: Blepharoplasty, Eyelid Surgery, and Brow Lift
Geographic Jurisdiction: Washington Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
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.
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05/10/2021 10:48:42 188.8.131.52