Local Coverage Determination (LCD) - JE Part A
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 CPT/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). How to Use The MCD
Access the below related information from this page.
- Active LCDs
- Contractor Advisory Committee (CAC)
- Proposed LCDs
- LCD Reconsideration Process
- LCD Review and Revision
- LCD Timelines for Proposed to Active
- LCD: New LCD Request Process
- Open Public Meeting
- Retired LCDs
CMS has determined and published applicable timelines. View these in the CMS Internet Only Manual (IOM), Medicare Program Integrity Manual, Publication 100-08, Chapter 13.
Four Stages of Process
- Comment Period - Comment Period is a Minimum of 45 Days - Noridian considers all comments from the public, and the medical community. The comment period begins when the policy is distributed to medical providers, and organizations. Noridian responds to comments via comment/response notations within the LCD under the section Advisory Committee Meeting Notes.
- Comment Review Period, with Development of Responses - This timeframe begins after the 45 day Comment Period ends. During this period the Contractor Medical Directors (CMD) review all comments, develop responses, update the LCD, and prepare for the Notice Period.
- Notice Period - Once the LCD is amended in accordance with the responses to the comments, the LCD is posted to the CMS website in the Medicare Coverage Database (MCD) as a Final LCD, however; it is not yet Active. Providers do have 45 days from the date of posting notice to implement billing changes and educate staff before the LCD implementation.
- Active Period (LCD is in Effect) - The actual LCD implementation date is the effective date and occurs on the 46th day from the first date of the Notice Period. Located in the body of the LCD under the, "Original Determination Effective Date," or "Revision Effective Date" depending on whether the LCD is new or revised.
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 an update to a HCPCS code or ICD-10-CM code. 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.
Last Updated Mon, 25 Sep 2023 13:23:06 +0000