CodeMap® LCD-L36000

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: L36000 Status: A-Approved
LCD Title: Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain
Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions
Original Determination Effective Date: 12/17/2015
Original Determination Ending Date:
Revision Effective Date: 06/27/2024
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act, Section 1833(e) 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) allows coverage and payment for services considered medically reasonable and necessary.

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06/25/2025 03:46:11 18.97.14.90

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