Policies (LCDs and NCDs)
A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor (MAC) whether to cover a particular service on a MAC-wide, basis. The LCDs are located on the CMS website in a Medicare Coverage Database (MCD).
|Local Coverage Determination (LCD)||LCDs and Policy Articles (PAs) define coverage criteria, payment rules and documentation that are applied to DMEPOS claims processed by DME MACs|
|LCD Reconsideration Process||LCD Reconsideration Process is a mechanism by which interested parties can request a revision to an LCD. It is available only for final LCDs. The whole LCD or any provision of the LCD may be reconsidered.|
|Documentation Checklists||Documentation checklists are provided to assist suppliers in gathering documentation|
|Physician Resource Letters||DME suppliers may provide these letters to physicians to assist in obtaining required documentation|
|National Coverage Determination (NCD)||An NCD is a national policy granting, limiting or excluding Medicare coverage for a specific medical item or service. These are developed and published by CMS and apply to all states. NCDs are made through an evidence-based process, with opportunities for public participation. In rare instances, if there is contradicting information in the NCD and LCD, the NCD overrides the LCD.|
- Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC
- CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 – Sections 110-140
- IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 20 – DMEPOS
- IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 5 – Special DME Review Considerations
Last Updated Dec 23, 2016
CPT and ADA End User License Agreement for Providers
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Last Updated Jun 08, 2016