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LCD ID Number: L37176 Status: A-Approved
LCD Title: White Cell Colony Stimulating Factors
Geographic Jurisdiction: North Carolina Other Jurisdictions
Original Determination Effective Date:
06/12/2017
Original Determination Ending Date:
Revision Effective Date:
10/17/2024
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 reasonable and necessary for the diagnosis or treatment of illness or to improve the functioning of a malformed body member.
42 CFR §411.15(k)(1) Particular services excluded from coverage are those services that are not reasonable or 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 15, §50 Drugs and Biologicals and §50.4.1 Approved Use of Drug.
CMS Manual System, Pub. 100-20, One-Time Notification, Transmittal 1542, Change Request 9284, dated September 4, 2015.
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