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.

Topic Brief Description

Local Coverage Determination (LCD)

An 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).

MolDX View coverage and reimbursement information for molecular diagnostic tests.

National Coverage Determination (NCD)

View additional Noridian coverage requirement articles.

An NCD This link will take you to an external website.  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 Coverage Articles

Medicare contractors post articles into the Medicare Coverage Database (MCD). Articles address local coverage, coding or medical review related billing and claims considerations, and may include any newly developed educational materials, coding instructions or clarification of existing medical review related billing or claims policy.

View coverage details on topics found outside NCDs and LCDs.

Self Administered Drugs (SADs)

 

View information on how you are able to determine which drugs are usually self-administered by the patient and see the SAD exclusion list.

 

Last Updated Aug 20, 2015

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Last Updated May 04, 2015