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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: L37228 Status: A-Approved LCD Title: Wound Care Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions Original Determination Effective Date: 04/16/2018 Original Determination Ending Date: Revision Effective Date: 03/27/2025 Revision End Date: CMS National Coverage Policy: Italicized font -represents CMS national NCD language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national NCD language/wording. 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 excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. A service must be reasonable and necessary, which includes services which are safe and effective, furnished in the appropriate setting and ordered and/or furnished by qualified personnel. Title XVIII of the Social Security Act section 1862 (a) (1) (D). This section states that no Medicare payment may be made under part A or part B for any expenses incurred for items or services that are investigational or experimental. CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Sections 100 - Surgical Dressings. Splints, Casts, and Other Devices Used for Reductions of Fractures and Dislocations 220 – Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services, Under Medical Insurance and 230 – Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology. CMS IOM Publication 100-03 Medicare Coverage Determinations (NCD) Manual, Chapter 1, Part One, Section 20.29: Hyperbaric Oxygen Therapy (Section C, Topical Application of Oxygen). CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, Section 270 – Wound Treatment 270.1 Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds 270.2 Noncontact Normothermic Wound Therapy (NNWT) 270.3 Blood Derived Products for Chronic Non-Healing Wounds 270.6 Infrared Therapy Devices MLM SE17027 Clarification of Billing and Payment Policies for Negative Pressure Wound Therapy (NPWT) Using a Disposable Device CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 - Reasonable and Necessary Provisions in an LCD. 42 Code of Federal Regulations (CFR) § 410.20 - Physicians' services Sorry, you need to login or register to view additional sections of this Medicare policy. *