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LCD ID Number: L34528 Status: A-Approved
LCD Title: Blepharoplasty, Blepharoptosis and Brow Lift
Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions
Original Determination Effective Date:
10/01/2015
Original Determination Ending Date:
Revision Effective Date:
12/28/2023
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act section 1862(a)(10). This section excludes cosmetic surgery, except as required to repair an accidental injury or for improvement of the function of a malformed body member.
Title XVIII of the Social Security Act section 1833 (e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 16 – General Exclusion from Coverage, Section 20 – Services Not Reasonable and Necessary and Section 120 – Cosmetic Surgery.
CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 13 - Radiology Services and Other Diagnostic Procedures, Section 10 - ICD Coding for Diagnostic Tests and Chapter 23 – Fee Schedule Administration and Coding Requirements, Section 10 – Reporting ICD Diagnosis and Procedure Codes.
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