CodeMap® LCD-L37205

Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor

Contractor Number: 08202
Contractor Type: MAC B

LCD Information

LCD ID Number: L37205 Status: A-Approved
LCD Title: Chemotherapy Drugs and their Adjuncts
Geographic Jurisdiction: Michigan Other Jurisdictions
Original Determination Effective Date: 09/16/2017
Original Determination Ending Date:
Revision Effective Date: 11/30/2023
Revision End Date:
CMS National Coverage Policy:
Italicized font -represents CMS national NCD language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national NCD language/wording.

CMS Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, Section 50, Drugs and Biologicals

CMS Pub. 100-04 Medicare Claims Processing Manual, Chapter 12, Physician/Nonphysician Practitioners, Section 30.5, Payment for Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions

CMS Pub. 100-04 Medicare Claims Processing Manual, Chapter 14, Ambulatory Surgical Centers, Section 10, General

CMS Pub. 100-04 Medicare Claims Processing Manual, Chapter 17, Drugs and Biologicals, Section 90.2, Drugs, Biologicals, and Radiopharmaceuticals

CR 9749: August 24, 2016, CPT G0498: Chemo extend IV infusion with pump

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