Local Coverage Determinations

Local coverage determinations (LCDS) are defined in Section 1869(f)(2)(B) of the Social Security Act (the Act). This section states: "For purposes of this section, the term 'local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary- or carrier-wide basis under such parts, in accordance with section 1862(a)(1)(A)."

As a result of the Benefits Improvement and Protection Act of 2000 (BIPA 2000), all Local Medical Review Policies (LMRPs) were converted to LCDs. The difference between LCDs and previously written LMRPs is that LCDs contain only reasonable and necessary conditions of coverage as allowed under section 1862(a)(1)(A) of the Act. LMRPs may have also contained other information such as coding and payment guidelines. Since coding and payment information is not contained in LCDs, Contractors communicate such information in related articles.

Downloads
There are no Downloads
Related Links Inside CMS
LCDs by Contractor LCDs by State LCDs Alphabetically Coverage Center Medicare Coverage Database
Related Links Outside CMS
There are no Related Links Outside CMS

Page Last Modified: 07/16/2010 10:33:11 AM
Help with File Formats and Plug-Ins