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).

National Coverage Determinations (NCDs) are developed by CMS to describe the circumstances for Medicare coverage nationwide for a specific medical service procedure or device

NCDs are found in the Medicare Coverage Database This link will take you to an external website. and National Coverage Determinations Manual This link will take you to an external website..

Topic Brief Description
Documentation Checklists Documentation checklists are provided to assist suppliers in gathering documentation
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.
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
National Coverage Determination (NCD) This link will take you to an external website. 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.
Physician Resource Letters DME suppliers may provide these letters to physicians to assist in obtaining required documentation

 

Resources

Last Updated Mar 07, 2017

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Last Updated Jun 08, 2016