What is the Medicare Coverage Database (MCD)?
The Medicare Coverage Database (MCD) is a searchable repository that has information related to what’s covered and not covered by Original Medicare. The MCD document types include National Coverage Determinations (NCDs), National Coverage Analyses (NCAs), Local Coverage Determinations (LCDs), Proposed LCDs, local coverage Articles, and Draft Articles.
The database also includes other types of National Coverage policy related documents, including Coding Analyses for Labs (CALs), Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) proceedings, Technical Assessments (TAs), and Medicare coverage guidance documents. Find more information on each of these document types on the Coverage Document Descriptions tile on the MCD Help & Resources page.
Why Would Someone Use the Coverage Database?
As a health care provider, you should understand Medicare coverage before providing services or items to Medicare patients. Because extensive coverage information is available, we expect health care providers to know Medicare coverage requirements to anticipate payment denial. If you don’t give the patient enough written advance notice that Medicare will likely deny the service or item, you’re financially liable.
However, if you give the patient proper written advance notice that we will likely deny payment for the service or item, and show this action on the claim, Medicare may hold the patient liable.
Medicare Contractors, providers, suppliers, and associated personnel use the MCD. Medicare patients, family members, and caregivers may visit Medicare.gov, the official U.S. Government site for people with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools.
Below the MCD Search, find a list of resources called information cards. They include the Notice Board for key topics and site updates, a link to the Beneficiary Guide to help patients who may search the MCD for information, and the Public Comments card that lists National documents open for public comment. Access the comment submission form from this card.
Figure 1: Beneficiary Information Card
Background: Medicare Coverage and Coverage Determinations
The Social Security Act (the Act) is the primary authority for all coverage provisions and subsequent policies. Medicare law limits coverage to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury, and within the scope of a Medicare benefit category. In certain cases, CMS develops an NCD for an item or service to be applied on a national basis for all people with Medicare meeting the criteria for coverage. Medicare Administrative Contractors (MACs) develop LCDs when no NCD exists or when they need to further define an NCD.
How Up to Date is the MCD?
CMS updates the national coverage information in the MCD in real time. For local coverage updates, CMS captures that information on Sunday night at midnight, and the MCD displays it on the following Thursday. We also update the national and local coverage download files weekly on Thursday. In addition, you should go to your MAC’s website and subscribe to their email list to know of new or changing LCDs.
How to Find the MCD
You can find the MCD on the MCD webpage on CMS.gov by choosing Medicare, then Coverage, and then Medicare Coverage Database.