CodeMap® LCD-L35998

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: L35998 Status: A-Approved
LCD Title: Non-Coronary Vascular Stents
Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions
Original Determination Effective Date: 10/01/2015
Original Determination Ending Date:
Revision Effective Date: 01/01/2023
Revision End Date:
CMS National Coverage Policy:
CMS Pub. 100-03 Medicare National Coverage Determination (NCD) Manual, Chapter 1-Coverage Determinations, Part 1, Section 20.7-Percutaneous Transluminal Angioplasty
National Coverage Analysis (NCA) for Percutaneous Transluminal Angioplasty (PTA) and Stenting of the Renal Arteries (CAG-00085R4)
CMS Pub. 100-08 Medicare Program Integrity Manual, Chapter 13- Local Coverage Determinations, Section 13.5 - Content of an LCD and Section 13.5.1-Reasonable and Necessary Provisions in LCDs

Social Security Act (Title XVIII) Sections:
1862 (a)(1)(A) Medically Reasonable & Necessary
1862 (a)(1)(D) Investigational or Experimental
1862 (a)(7) Screening (Routine Physical Checkups)

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06/25/2025 02:39:47 18.97.14.90

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