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Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor Contractor Number: 05302 Contractor Type: MAC B

LCD Information

LCD ID Number: L34536 Status: A-Approved LCD Title: Treatment of Varicose Veins of the Lower Extremities Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 08/31/2023 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act §1862(a)(1)(a). This section excludes coverage and payment for items and services that are not considered reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the function of a malformed body member. Title XVIII of the Social Security Act §1862(a)(10). Cosmetic surgery is excluded from coverage. Title XVIII of the Social Security Act §1862(a)(7). This section excludes routine physical examinations and services. Title XVIII of the Social Security Act §1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Change Request 10901, Local Coverage Determinations (LCDs) CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 - Reasonable and Necessary Provisions in an LCD. Sorry, you need to login or register to view additional sections of this Medicare policy. *