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Contractor Information

Contractor Name: Novitas Solutions, Inc. - Full list of policies of this Medicare Contractor Contractor Number: 12101 Contractor Type: MAC A

LCD Information

LCD ID Number: L38809 Status: A-Approved LCD Title: Botulinum Toxins Geographic Jurisdiction: Delaware Other Jurisdictions Original Determination Effective Date: 03/21/2021 Original Determination Ending Date: Revision Effective Date: Revision End Date: CMS National Coverage Policy: This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for botulinum toxins. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for botulinum toxins and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site. IOM Citations: CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 1, Section 30 Drugs and Biologicals Chapter 6, Section 20.5.2 Coverage of Outpatient Therapeutic Services Incident to a Physician’s Service Furnished on or After January 1, 2010 Chapter 15, Section 50 Drugs and Biologicals, Section 60 Services and Supplies Chapter 16, Section 120 Cosmetic Surgery CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD Social Security Act (Title XVIII) Standard References: Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury. Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations. Title XVIII of the Social Security Act, Section 1862(a)(10) excludes coverage for cosmetic surgery. Title XVIII of the Social Security Act, Section 1861(t). This section addresses drugs and biologicals definitions. Sorry, you need to login or register to view additional sections of this Medicare policy. *