What is a Local Coverage Determination (LCD)?
The Benefit Improvement Protection Act (BIPA) §522 created Local Coverage Determinations (LCDs) that consist only of reasonable and necessary information. LCDs are contractor-developed coverage policies, pertaining to services or items not addressed in National Coverage Determinations (NCDs) or program manuals. LCDs contain coding and utilization guidelines as well as descriptive passages. LCDs sometimes contain some Centers for Medicare & Medicaid Services (CMS) language as well, which is italicized.
LCDs are developed for various reasons, some of which are:
- To define the appropriate use of new technologies
- To address services with an abuse history or potential
- High volume, high dollar services
LCDs are subject to the Carrier Advisory Committee (CAC) and public comment period processes. They can be readily revised as new data becomes available and is supplied to the Contractor Medical Director.
All LCDs, both current and those under development, from all contractors in the country are located on the CMS Website at: http://www.cms.hhs.gov/center/coverage.asp 
If there are "Coding Instructions" and/or "Reasons for Denial" for an LCD, these appear in a companion article entitled with the policy name/LCD Title. WPS Medicare indicates on our index if there is an associated article with an LCD with an information icon.
Also, in the LCD, under the section entitled "Notes," there will be a statement indicating whether or not there is a companion article for this LCD.
Page Last Updated: Monday, 21-Jan-2008 15:37:15 CST
