Medical Policies

The Centers for Medicare and Medicaid Services (CMS) assigns Medicare Administrative Contractors (MACs) the task of developing Local Coverage Determinations (LCDs) to describe reasonable and necessary services within the Medicare program. The LCD process as described in the Medicare Program Integrity Manual (PIM), Chapter 13 (PDF, 124 KB) provides requirements for submission and review of new LCD requests, LCD reconsideration requests, and the opportunity to request an informal meeting to ensure all required documentation is correctly submitted to the MAC upon submission of your request. A list of LCDs can be found under LCDs, NCDs, Coverage Articles. This page also includes a table of all active LCDs, related articles to the LCD, and applicable CPT/HCPCS codes.

The PIM, Chapter 13 discusses information regarding LCD development meetings described as Contractor Advisory Committee (CAC) Meetings and Open Meetings. Information regarding past and upcoming meetings can found under LCD Development Meetings or by clicking on one of the icons above.

CMS assigns MACs the task of developing coverage articles that give direction on how to bill or code for a service or to provide education on a specific topic.  A list of Medicare Coverage Database (MCD) articles can be found under LCDs, NCDs, Coverage Articles. This page also includes a table of all active MCD articles, the related LCD (if applicable), and applicable CPT/HCPCS codes.

National Coverage Determinations (NCDs) are owned and maintained by CMS. A list of NCDs and a link on how to request reconsideration of an NCD can be found under LCDs, NCDs, Coverage Articles.