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Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor Contractor Number: 14512 Contractor Type: MAC B

LCD Information

LCD ID Number: L39139 Status: A-Approved LCD Title: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound Geographic Jurisdiction: Vermont Other Jurisdictions Original Determination Effective Date: 12/24/2023 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 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)(1)(D) addresses services that are determined to be investigational or experimental. CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16, §10 General Exclusions from Coverage CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §30A Physician’s Services CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 30, §50.3.1 Mandatory ABN Uses Sorry, you need to login or register to view additional sections of this Medicare policy. *