Local Coverage Determination (LCD)

Excision of Malignant Skin Lesions

L33818

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L33818
Original ICD-9 LCD ID
Not Applicable
LCD Title
Excision of Malignant Skin Lesions
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 01/08/2019
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

Issue

Issue Description
Issue - Explanation of Change Between Proposed LCD and Final LCD

CMS National Coverage Policy

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Excision of Malignant Skin Lesions. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for Excision of Malignant Skin Lesions and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site. 

Internet Only Manual (IOM) Citations:

  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD 

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
  • Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

History/Background and/or General Information

A skin lesion is any alteration in the normal skin architecture. Lesions can be benign, pre-malignant or malignant. The most common malignant lesions are Basal Cell Carcinomas (BCC), Squamous Cell Carcinomas (SCC) and Melanomas.

Four of the most common methods of treatment of malignant skin lesions are:

  • Surgical excision,
  • Electrodesiccation (tissue destruction by heat),
  • Radiation therapy, or
  • Cryosurgery (tissue destruction by freezing)

Covered Indications

The treatment of choice for malignant skin lesions is complete excision that includes a variable margin of surrounding tissue in order to eradicate microscopic tumor cells, which may have spread beyond the visible borders of the lesion.

The excision of a malignant skin lesion including margins will be considered medically necessary when a pathology report verifies the existence of a malignancy.

Limitations

As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.

Summary of Evidence

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Analysis of Evidence (Rationale for Determination)

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Proposed Process Information

Synopsis of Changes
Changes Fields Changed
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Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

Additional ICD-10 Information

General Information

Associated Information

Documentation Requirements

Please refer to the Local Coverage Article: Billing and Coding: Excision of Malignant Skin Lesions (A57660) for documentation requirements that apply to the reasonable and necessary provisions outlined in this LCD.

Utilization Guidelines

Please refer to the Local Coverage Article: Billing and Coding: Excision of Malignant Skin Lesions (A57660) for utilization guidelines that apply to the reasonable and necessary provisions outlined in this LCD.

Sources of Information

First Coast Service Options, Inc. reference LCD number – L29424

American Medical Association. (2000). Reviewing of the integumentary excision lesion codes (11400-11646). cpt™Assistant,10(8), 5-7.

Arora, A. & Attwood, J. (2009). Common skin cancers and their precursors. Surgical Clinics of North America 89(3).

Rigel, D.S. & Carucci, J.A. (2000). Malignant melanoma: Prevention, early detection, and treatment in the 21st century. CA: A Cancer Journal for Clinicians [On-Line], 50.

Bibliography

N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
01/08/2019 R4

Revision Number : 4
Publication: November 2019 connection
LCR B2019-031

Explanation of Revision: Based on Change Request (CR) 10901, the LCD was revised to remove all billing and coding and all language not related to reasonable and necessary provisions (“Bill Type Codes,” “Revenue Codes,” “CPT/HCPCS Codes,” “ICD-10 Codes that Support Medical Necessity,” “Documentation Requirements” and “Utilization Guidelines” sections of the LCD) and place them into a newly created billing and coding article. During the process of moving the ICD-10-CM diagnosis codes to the billing and coding article, the ICD-10-CM diagnosis code ranges were broken out and listed individually. In addition, the Social Security Act and IOM reference sections were updated. The effective date of this revision is for claims processed on or after January 8, 2019, for dates of service on or after October 3, 2018.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this LCD.

  • Other (Revision based on CR10901)
10/01/2018 R3

Revision Number: 3
Publication: September 2018 Connection
LCR B2018-017

Explanation of Revision: Based on CR 10847 (Annual 2019 ICD-10-CM Update) the LCD was revised. Deleted ICD-10-CM diagnosis code D03.12, changing ICD-10-CM diagnosis code range D03.10-D03.12 to ICD-10-CM diagnosis code range D03.10-D03.122. Deleted ICD-10-CM diagnosis code D04.12, changing ICD-10-CM diagnosis code range D04.10-D04.12 to ICD-10-CM diagnosis code range D04.10-D04.122. In addition, the LCD was revised to indicate that diagnosis codes were added within existing diagnosis code ranges. The effective date of this revision is based on date of service.

10/01/2018:  At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R2 Revision Number: 2
Publication: February 2016 Connection
LCR B2016-005

Explanation of revision: This LCD was revised to add ICD-10-CM diagnosis code range C4A.52-C4A.72 for ‘Procedure Codes 11600-11606,’ diagnosis codes C4A.4 and C4A.51 and diagnosis range C4A.60-C4A.72 for ‘Procedure Codes 11620-11626,’ and diagnosis ranges C4A.0-C4A.39 and C4A.8-C4A.9 for ‘Procedure Codes 11640-11646’ in the “ICD-10 Codes that Support Medical Necessity” section of the LCD. The effective date of this revision is for claims processed on or after 02/08/2016, for dates of service on or after 10/01/15.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R1 Revision Number: 1
Publication: November 2015 Connection
LCR B2015-083

Explanation of revision: This LCD was revised to add additional ICD-10-CM diagnosis codes to the “ICD-10 Codes that Support Medical Necessity” section of the LCD. ICD-10-CM diagnosis code ranges D03.51-D03.59, D03.60-D03.62, and D03-70-D03.72 was added for procedure codes 11600-11606, ICD-10-CM diagnosis code D03.4 and code ranges D03.60-D03.62 and D03.70-D03.72 were added for procedure codes 11620-11626, and ICD-10-CM diagnosis codes D03.0, D03.10-D03.12, D03.20-D03.22, D03.30-D03.39 and diagnosis code D03.8 were added for procedure codes 11640-11646. Additionally, ICD-10-CM diagnosis code D04.5 was removed from the ICD-10-CM diagnosis code list for procedure codes 11620-11626 and added to the ICD-10-CM diagnosis code list for procedure codes 11600-11606, as it was mistakenly added to the diagnosis list for procedure codes 11620-11626 . The effective date of this revision is for claims processed on or after 11/12/2015, for dates of service on or after 10/01/15.
  • Revisions Due To ICD-10-CM Code Changes
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Associated Documents

Attachments
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Related National Coverage Documents
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Public Versions
Updated On Effective Dates Status
11/22/2019 01/08/2019 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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