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Facial Prostheses - Policy Article - Effective October 2015
Article A52463 · 13 versions, 2015 to today · last changed 2020-01-01 (R12)
Version 5 of Article A52463: in force by CMS's dates 2016-07-01 to 2016-06-30. The policy text on this page comes from this archived version.
JA · Noridian 16013
JB · CGS 17013
JC · CGS 18003
JD · Noridian 19003
source
CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.
Sections in this version: Article Text · Coding Information. Plus 1 section marked N/A in this version.
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Version history, Article A52463
CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.
Revision history, every version
CMS's own change log, quoted, 7 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.
R12 · 2020-01-01 · v32
Revision Effective Date: 01/01/2020 CODING GUIDELINES: Added: “Prosthetic devices that are custom fabricated for the individual beneficiary are not solely restricted to standard methods of fabrication and can include alternative fabrication methods (e.g., additive manufacturing). Correct coding of custom fabricated items includes compliance with the HCPCS long description of the individual HCPCS code, along with any other published coding guidelines.” as clarification 09/18/2025: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R6 · 2019-03-01 · v13
Revision Effective Date: 03/01/2019 CODING GUIDELINES: Revised: RT and LT modifier billing instructions 02/07/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R5 · 2018-01-01 · v11
Revision Effective Date: 01/01/2018 Added: Clarifying language regarding use of miscellaneous code L8048 04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.
R4 · 2017-01-01 · v9
Revision Effective Date: 01/01/2017 Added: Policy specific documentation requirements from Documentation section of LCD RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements Language Article
R3 · 2016-07-01 · v7
Revision Effective Date: 07/01/2016 Updated: Title to remove effective date
R2 · 2016-07-01 · v5
Effective July 1, 2016 oversight for DME MAC Articles is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the Articles.
R1 · 2015-10-01 · v4
Revision Effective Date: 08/01/2015 NON-MEDICAL NECESSITY COVERAGE & PAYMENT RULES: Revised: Language for HCPCS codes A4450, A4452, A5120, that are billed without correct modifier
Receipts for auditors
Version 5 of Article A52463, shown on this page: in force by CMS's dates 2016-07-01 to 2016-06-30. Archived 2026-09-26. CMS's copy · Our archived file. 3 of 3 sections are proven word-identical to the archived file.
Every archived version of Article A52463 (13 versions, CMS's dates, window by the as-of rule).
| Document | Version | In force | Archived on | Verify |
|---|---|---|---|---|
| Article A52463 | version 2 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52463 | version 4 | 2015-10-01 to 2016-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52463 | version 5 shown | 2016-07-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52463 | version 7 | 2016-07-01 to 2016-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52463 | version 9 | 2017-01-01 to 2017-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52463 | version 11 | 2018-01-01 to 2019-02-28 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52463 | version 13 | 2019-03-01 to 2019-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52463 | version 18 | 2020-01-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52463 | version 21 | 2020-01-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52463 | version 25 | 2020-01-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52463 | version 28 | 2020-01-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52463 | version 30 | 2020-01-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52463 | version 32 | 2020-01-01 to today | 2026-09-26 | CMS's copy · Our archived file |
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