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
NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.
CPT codes, descriptors and other data only are copyright 2014 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.
Last Updated Feb 03, 2015