What is Medicare LCD?

Local Coverage Determination
What’s a “Local Coverage Determination” (LCD)? LCDs are decisions made by a Medicare Administrative Contractor (MAC) whether to cover a particular item or service in a MAC’s jurisdiction (region) in accordance with section 1862(a)(1)(A) of the Social Security Act.

What does it mean when Medicare retires an LCD?

Answer: When a Local Coverage Determination (LCD) has been retired, only those services submitted for dates on which the policy was active can be denied based on not meeting the LCD requirements.

What happens when an LCD is retired?

When LCDs are retired, the services are still covered and any related NCDs or coverage listed in the Internet Only Manual (IOM) will continue to apply. Although a policy may be retired, services must still be medically reasonable and necessary.

What is difference between LCD and NCD?

When a contractor or fiscal intermediary makes a ruling as to whether a service or item can be reimbursed, it is known as a local coverage determination (LCD). When CMS makes a decision in response to a direct request as to whether a service or item may be covered, it’s known as a national coverage determination (NCD).

What is an LCD code?

An LCD is a determination by a Medicare Administrative Contractor (MAC) whether to cover a particular service on a. Coverage criteria is defined within each LCD , including: lists of CPT /HCPCs codes, codes for which the service is covered or considered not reasonable and necessary.

What is a Local Coverage Determination ( LCD ) in Medicare?

A Local Coverage Determination (LCD) is a decision made by a Medicare Administrative Contractor (MAC) on whether a particular service or item is reasonable and necessary, and therefore covered by Medicare within the specific jurisdiction that the MAC oversees. MACs are Medicare contractors that develop LCDs and process Medicare claims.

Where can I find the LCD version of Medicare?

In the table below, select an ” LCD Title” link to view the locally hosted LCD PDF. To access the official LCD version, visit the CMS Medicare Coverage Database (MCD) .

What do you need to know about the Medicare MCD?

The Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions.

What happens to a Medicare LCD when it is removed?

However, when a particular LCD has its codes removed, the Medicare Administrative Contractor (MAC) will create a Billing and Coding Article which will contain the codes. The LCD and the Billing and Coding Article are companion documents.

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