Local Coverage Determination (LCD) - JA DME
Local Coverage Determination (LCD)
An LCD is a determination by a Medicare Administrative Contractor (MAC) whether to cover a particular service on a MAC-wide, basis. Coverage criteria is defined within each LCD, including: lists of HCPCS codes, ICD-10 codes for which the service is covered or considered not reasonable and necessary. View published Active LCDs on our website and access others located within the CMS Medicare Coverage Database (MCD).
Access the below related information from this page.
- Active LCDs
- Archived/Retired LCDs
- Contractor Advisory Committee (CAC)
- New LCD Request Process
- LCD Reconsideration Process
- LCD Review and Revision
- Open Meeting
- Proposed LCDs
LCD Review and Revision
Noridian shall review and appropriately revise the affected LCD within 90 days of the publication of program instruction (e.g., Program Memorandum, manual change) containing:
- A new or revised National Coverage Determination (NCD)
- A new or revised coverage provision in an interpretive manual; or
- A change to national payment policy.
The MCD will notify contractors of each LCD that is affected by HCPCS or diagnosis code updates. Noridian shall review and approve and/or appropriately revise affected LCDs within 120 days of the date of notification. If there are major changes, Noridian shall revise the effective date, revision number and revision history.
Noridian may periodically review and revise LCDs to ensure they remain accurate based upon the CMS NCDs, coverage provisions in interpretive manuals, national payment policies, and national coding policies.
- CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 13
- CMS Welcome to The Medicare Coverage Database - How to Use the Site