Printer Friendly Version

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: L34615 Status: A-Approved LCD Title: Visual Fields Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 05/29/2025 Revision End Date: CMS National Coverage Policy: 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. Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary. CMS Pub 100-02, Medicare Benefit Policy Manual, Chapter 16 – General Exclusions From Coverage, Section 90 – Routine Services and Appliances. 42 CFR Section 410.32 Diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) and diagnostic tests payable under the Physicians Fee Schedule must be furnished under the appropriate level of supervision by the physician. Sorry, you need to login or register to view additional sections of this Medicare policy. *