CodeMap® LCD-L39573

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11202
Contractor Type: MAC B

LCD Information

LCD ID Number: L39573 Status: A-Approved
LCD Title: Scalp Cooling for the Prevention of Chemotherapy-Induced Alopecia
Geographic Jurisdiction: South Carolina Other Jurisdictions
Original Determination Effective Date: 11/12/2023
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.

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, §110.6 Scalp Hypothermia During Chemotherapy to Prevent Hair Loss shall not be construed to prevent coverage.

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05/13/2025 08:00:41 18.97.9.173

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