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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 11502 Contractor Type: MAC B

LCD Information

LCD ID Number: L39121 Status: A-Approved LCD Title: Treatment of Varicose Veins of the Lower Extremities Geographic Jurisdiction: North Carolina Other Jurisdictions Original Determination Effective Date: 04/03/2022 Original Determination Ending Date: Revision Effective Date: 11/16/2023 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 injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups. 42 CFR §411.15(k)(1) Any services that are not reasonable and necessary for 1 of the following purposes: For the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.4 Reasonable and Necessary Provisions in LCDs CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §220.5 Ultrasound Diagnostic Procedures Sorry, you need to login or register to view additional sections of this Medicare policy. *