CodeMap® LCD-L39905

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: L39905 Status: A-Approved
LCD Title: Cataract Surgery
Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions
Original Determination Effective Date: 10/13/2024
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording.

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.

Code of Federal Regulations:

42 CFR, § 410.32 indicates that 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.

CMS Publications:

CMS Publication 100-02, Medicare Benefit Policy Manual,

Chapter 15, § 30.4 Optometrist’s Services and § 120 Prosthetic Devices

Chapter 16, § 10 General Exclusions from Coverage and § 90 Routine Services and Appliances

CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 1:

10.1 Use of Visual Tests Prior to and General Anesthesia during Cataract Surgery

80.10 Phaco-Emulsification Procedure - Cataract Extraction

80.12 Intraocular Lenses

80.8 Endothelial Cell Photography

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06/25/2025 02:22:06 18.97.14.90

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