What is an LCD and NCD?

When a contractor or fiscal intermediary makes a ruling as to whether a service or item can be reimbursed, it is known as a local coverage determination (LCD). When CMS makes a decision in response to a direct request as to whether a service or item may be covered, it’s known as a national coverage determination (NCD).

What is CMS LCD?

What’s a “Local Coverage Determination” (LCD)? LCDs are decisions made by a Medicare Administrative Contractor (MAC) whether to cover a particular item or service in a MAC’s jurisdiction (region) in accordance with section 1862(a)(1)(A) of the Social Security Act.

What does LCD mean in medical billing?

Local Coverage Determination
Local Coverage Determination (LCD) An LCD is a determination by a Medicare Administrative Contractor (MAC) whether to cover a particular service on a. Coverage criteria is defined within each LCD , including: lists of CPT /HCPCs codes, codes for which the service is covered or considered not reasonable and necessary.

What is LCD in medical billing?

An LCD is a determination by a Medicare Administrative Contractor (MAC) whether to cover a particular service on a. Coverage criteria is defined within each LCD , including: lists of CPT /HCPCs codes, codes for which the service is covered or considered not reasonable and necessary.

What is CMS coverage?

Medicare provides coverage for items and services for over 55 million beneficiaries. The vast majority of coverage is provided on a local level and developed by clinicians at the contractors that pay Medicare claims.

What is NCD in medical billing?

A national coverage determination (NCD) is a United States nationwide determination of whether Medicare will pay for an item or service. It is a form of utilization management and forms a medical guideline on treatment.

When does CMS make a LCD or NCD?

When CMS makes a decision in response to a direct request as to whether a service or item may be covered, it’s known as a national coverage determination (NCD). LCD determination is always based on medical necessity. LCDs apply only to the area served by the contractor who made the decision.

What’s the difference between a NCD and a LCD?

When CMS makes a decision in response to a direct request as to whether a service or item may be covered, it’s known as a national coverage determination (NCD). LCD determination is always based on medical necessity. Both NCDs and LCDs establish policies that are specific to an item or service.

Where to find LCDs on the CMS website?

LCDs are frequently published on issues which have been seen as having a high error rate and needing further guidance and clarification. LCDs are located on the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database Web page.