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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: L39956 Status: A-Approved LCD Title: Total Shoulder Arthroplasty Geographic Jurisdiction: South Carolina Other Jurisdictions Original Determination Effective Date: 03/27/2025 Original Determination Ending Date: Revision Effective Date: 03/27/2025 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) indicates no payment may be made in the case of clinical care where items and services provided are in research and experimentation. CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.3 Evidentiary Content and §13.5.4 Reasonable and Necessary Provisions in LCDs Sorry, you need to login or register to view additional sections of this Medicare policy. *