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