What is a Local Coverage Determination?

A Local Coverage Determinations (LCDs) is a policy created by Medicare Administrative Contractor (MAC). The Benefit Improvement Protection Act (BIPA) §522 created Local Coverage Determinations (LCDs) that consist only of reasonable and necessary information. LCDs are carrier developed coverage policies, pertaining to services or items not addressed in NCDs or program manuals. LCDs contain coding and utilization guidelines as well as descriptive passages. LCDs sometimes contain some CMS language as well, which would be italicized. LCDs are developed for various reasons, some of which are:

1. To define the appropriate use of new technologies.
2. To address services with an abuse history or potential.
3. High volume, high dollar services.

All LCDs, both current and those under development from all Carriers in the country are located on the CMS Website and links to current LCDs for Iowa, Kansas, Missouri, and Nebraska can be found in the left-side navigation of the Policy/Coverage section.

Page Last Updated: Friday, 06-Nov-2009 14:06:46 CST