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Search for Medicare Local Coverage Determination

Search for Medicare Local Coverage Determination

How to Search for a Medicare LCD

Medicare Local Coverage Determination (or Medicare LCD) is categorized by the medical procedures and diagnoses or covered conditions of the patient.

Before you use the Medicare Coverage Database, Knowing the medical code relevant to your search is a good idea.  The Current Procedural Terminology (or CPT code, which is copyright (c) American Medical Association) listings are provided with descriptions from the American Medical Association descriptions.  For example, if you are searching for a Durable Medical Equipment (DME) or ambulance service, you will need to know the Healthcare Common Procedure Coding System (HCPCS) medical billing code.  LCDs are organized with “L” code unique numbers.

For example:

The LCD Title, “Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases”, has an LCD number which is: LCD ID L37606

You should also be aware of which Medicare Administrative Contractor authored the LCD and what region of the country or jurisdiction it applies to.  Furthermore, you should understand the effective date, retirement date, and whether the Local Coverage Determination is a Draft.

These are now organized as follows:

Searching for a Medicare Local Coverage Determination Article

Medicare LCDs have been reorganized to some extent, although the work is ongoing.  Some coverage determination information, such as medical coding guidelines and covered conditions, may be contained in an LCD-associated article, which will be delineated with an “A” code.

Molecular Diagnostic Services (MolDX)

The MolDX program was developed by Palmetto GBA in 2011 to identify and establish coverage and reimbursement for molecular diagnostic tests. This program:

  1. Is to identify unique molecular tests via registration to ease the complexity of claims processing and to track utilization.
  2. Sets clinical utility standards.
  3. Finalizes technical assessments of test data that has been published to ascertain coverage.
  4. Sets reimbursement rates

For example: “Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile NEXT GENERATION SEQUENCING Testing in Cancer” has an Article ID of A54901.

Generally, Articles accompany Medicare Local Coverage Determinations.

Generally, LCDs do not keep up with the innovation in genetic testing, where innovation has been rapid.

Related Topics

Medicare LCD

Genetic Test Local Coverage Determination

Esoteric Tests

Laboratory Testing CPT codes for medical billing

Infusion Therapy and Medicare Local Coverage Determinations

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Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.

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