CodeMap® LCD-L38213

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: L38213 Status: A-Approved
LCD Title: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions
Original Determination Effective Date: 12/16/2019
Original Determination Ending Date:
Revision Effective Date: 08/01/2024
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) 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.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

IOM Citations:

CMS Publication 100-04; Medicare Claims Processing Manual,

Chapter 4, Part B Hospital (Including Inpatient Hospital Part B and OPPS), Section 10 Hospital Outpatient Prospective Payment System (OPPS)

Chapter 13: Radiology Services and Other Diagnostic Procedures, Section 80 Supervision and Interpretation (S & I) Codes and Interventional Radiology

CMS IOM Publication 100-08, Medicare Program Integrity Manual,

Chapter 13, Local Coverage Determinations, Section 13.5.4 Reasonable and Necessary Provision in an LCD

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06/25/2025 03:02:20 18.97.14.90

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