Local Coverage Determinations

What is an LCD?

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).”

Upcoming meetings
Date MAC/Jurisdiction Location

Topic(s)

May 19, 2020 (PDF)

10 a.m. ET

Noridian/JA Virtual EIP Coverage Criteria for Cutaquig and Remove "etc." from R & N Guidelines

May 20, 2020 (PDF)

3:00 pm, ET

Noridian/JE,JF Teleconference Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease Draft LCD
May 28, 2020 (PDF)
2pm-4pm ET
CGS/JE

Multijurisdictional Teleconference/Webinar only

Facet Joint and Medial Nerve Branch Procedures

June 1, 2020 (PDF)

JM 12-2:00 PM ET; JJ 2:30 – 4:30 PM ET

Palmetto/JM, JJ Teleconference Only
  • Fluid Jet System in the Treatment of Benign Prostatic Hypertrophy (BPH)
  • Intravenous Immunoglobulin (IVIG)
  • Stretta Procedure
  • Transanal Endoscopic Surgery (TES)
  • Lab: Urine Drug Testing
  • MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test
  • MolDX: EndoPredict Breast Cancer Gene Expression Test
  • MolDX: Liquid Biopsies for Solid Organ Transplantation
  • MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells
  • MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer

June 9, 2020 (PDF)

6-8 P.M. ET

First Coast /JN Teleconference/Webinar Only Transcranial Magnetic Stimulation for Obsessive Compulsive Disorder (TMS for OCD)

June 9, 2020 (PDF)

6-8 P.M. ET

Novitas/JL, JH Teleconference/Webinar Only Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder

June 17, 2020

1:00 PM – 3:00 PM CST

WPS/J5, J8 Teleconference
  • DLXXXXX Fluid Jet System for LUTS/BPH
  • DL37913 MolDX: Breast Cancer Index TM (BCO) Gene Expression Test
  • DLXXXXX MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
  • DLXXXXX MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells
  • DLXXXXX MolDX: Liquid Biopsies for Solid Organ Transplantation
  • DL37663 MolDX: EndoPredict® Breast Cancer Gene Expression Test
  • DL38213 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
  • DLXXXXX Implantable Continuous Glucose Monitors (CGM)

June 18, 2020

4:00 PM
– 6:00
PM CST

WPS/J5 Teleconference
  • DLXXXXX Fluid Jet System for LUTS/BPH
  • DL37913 MolDX: Breast Cancer IndexTM (BCO) Gene Expression Test
  • DLXXXXX MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
  • DLXXXXX MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells
  • DLXXXXX MolDX: Liquid Biopsies for Solid Organ Transplantation
  • DL37663 MolDX: EndoPredict® Breast Cancer Gene Expression Test
  • DL38213 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
  • DLXXXXX Implantable Continuous Glucose Monitors (CGM)

June 22, 2020

6:00 PM – 8:00 PM CST

WPS/J8 Teleconference
  • DLXXXXX Fluid Jet System for LUTS/BPH
  • DL37913 MolDX: Breast Cancer IndexTM (BCO) Gene Expression Test
  • DLXXXXX MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
  • DLXXXXX MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells
  • DLXXXXX MolDX: Liquid Biopsies for Solid Organ Transplantation
  • DL37663 MolDX: EndoPredict® Breast Cancer Gene Expression Test
  • DL38213 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
  • DLXXXXX Implantable Continuous Glucose Monitors (CGM)

Click the date for more information on each meeting

Medicare Administrative Contractors

A / C / D / F / G / H / I / K / L / M / N / O / P / R / S / T / U / V / W

State Jurisdiction (J) Medicare Administrative Contractor (MAC)
Alabama

DME MAC - JC

A/B MAC - JJ

HH + H MAC - JM

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

Alaska

DME MAC - JD

A/B MAC - JF

HH+ H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

American Samoa

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Arizona

DME MAC - JD

A/B MAC - JF

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Arkansas

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

California

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Colorado

DME MAC - JC

A/B MAC - JH

HH + H MAC - J15

CGS Administrators, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

Connecticut

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

Delaware

DME MAC - JA

A/B MAC - JL

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

District of Columbia

DME MAC - JA

A/B MAC - JL

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

Florida

DME MAC - JC

A/B MAC - JN

HH + H MAC - JM

CGS Administrators, LLC

First Coast Service Options, Inc.

Palmetto GBA, LLC

Georgia

DME MAC - JC

A/B MAC - JJ

HH + H MAC - JM

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

Guam

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Hawaii

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Idaho

DME MAC - JD

A/B MAC - JF

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Illinois

DME MAC - JB

A/B MAC - J6

HH + H MAC - JM

CGS Administrators, LLC

National Government Services, Inc.

Palmetto GBA, LLC

Indiana

DME MAC - JB

A/B MAC - J8

HH + H MAC - JM

CGS Administrators, LLC

Wisconsin Physicians Service Government Health Administrators

Palmetto GBA, LLC

Iowa

DME MAC - JD

A/B MAC - J5

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Wisconsin Physicians Service Government Health Administrators

CGS Administrators, LLC

Kansas

DME MAC - JD

A/B MAC - J5

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Wisconsin Physicians Service Government Health Administrators

CGS Administrators, LLC

Kentucky

DME MAC - JB

A/B MAC - J15

HH + H MAC - JM

CGS Administrators, LLC

CGS Administrators, LLC

Palmetto GBA, LLC

Louisiana

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

Maine

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

Maryland

DME MAC - JA

A/B MAC - JL

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

Massachusetts

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

Michigan

DME MAC - JB

A/B MAC - J8

HH + H MAC - J6

CGS Administrators, LLC

Wisconsin Physicians Service Government Health Administrators

National Government Services, Inc.

Minnesota

DME MAC - JB

A/B MAC - J6

HH + H MAC - J6

CGS Administrators, LLC

National Government Services, Inc.

National Government Services, Inc.

Mississippi

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

Missouri

DME MAC - JD

A/B MAC - J5

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Wisconsin Physicians Service Government Health Administrators

CGS Administrators, LLC

Montana

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

Nebraska

DME MAC - JD

A/B MAC - J5

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Wisconsin Physicians Service Government Health Administrators

CGS Administrators, LLC

Nevada

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

New Hampshire

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

New Jersey

DME MAC - JA

A/B MAC - JL

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

National Government Services, Inc.

New Mexico

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

New York

DME MAC - JA

A/B MAC - JK

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

North Carolina

DME MAC - JC

A/B MAC - JM

HH + H MAC - JM

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

North Dakota

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

Northern Mariana Islands

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Ohio

DME MAC - JB

A/B MAC - J15

HH + H MAC - JM

CGS Administrators, LLC

CGS Administrators, LLC

Palmetto GBA, LLC

Oklahoma

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

Oregon

DME MAC - JD

A/B MAC - JF

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Pennsylvania

DME MAC - JA

A/B MAC - JL

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

Puerto Rico

DME MAC - JC

A/B MAC - JN

HH + H MAC - J6

CGS Administrators, LLC

First Coast Service Options, Inc.

National Government Services, Inc.

Rhode Island

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

South Carolina

DME MAC - JC

A/B MAC - JM

HH + H MAC - J M

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

South Dakota

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

Tennessee

DME MAC - JC

A/B MAC - JJ

HH + H MAC - JM

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

Texas

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

Utah

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

Vermont

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

Virgin Islands

DME MAC - JC

A/B MAC - JN

HH + H MAC - J6

CGS Administrators, LLC

First Coast Service Options, Inc.

National Government Services, Inc.

Virginia

DME MAC - JC

A/B MAC - JL
(includes Part B for counties of Arlington and Fairfax, and the city of Alexandria)
A/B MAC - JM
(excludes Part B for the counties of Arlington and Fairfax, and the city of Alexandria)

HH + H MAC - J15

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

CGS Administrators, LLC

Washington

DME MAC - JD

A/B MAC - JF

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

West Virginia

DME MAC - JC

A/B MAC - JM

HH + H MAC - J15

CGS Administrators, LLC

Palmetto GBA, LLC

CGS Administrators, LLC

Wisconsin

DME MAC - JB

A/B MAC - J6

HH + H MAC - J6

CGS Administrators, LLC

National Government Services, Inc.

National Government Services, Inc.

Wyoming

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

DME = Durable Medical Equipment
HH+H = Home Health and Hospice
A/B MAC = part A and part B Medicare Administrative Contractors

 

 

Page Last Modified:
05/19/2020 06:33 AM