Medicare LCD and Local Coverage Determinations

What is a Medicare LCD?

Social Security Act (the Act) Section 1869(f)(2)(B) defines Medicare Local coverage determinations (LCDS). This section provides:

To elaborate, the Social Security Act states, “For purposes of this section, the term ‘local coverage determination’ means a determination by a fiscal intermediary.

(A fiscal intermediary is now called a Medicare Administrative Contractor, or ‘MAC.’ ) or a carrier under [Medicare] part A or part B.

The last part of the Act states, “…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).”

What is a Medicare NCD?

In short, Medicare National Coverage Determinations, or Medicare NCDs, broadly set national policy.  NCDs are supposed to be ‘evidence-based,’ meaning they are based on objective medical data.  CMS uses “MEDCAC” to do this.  Independent guidance is found in the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC).  MEDAC provides independent guidance and expert advice to CMS on specific clinical topics.

Medicare LCD Modernization

To elaborate, U.S. Office of the Inspector General (OIG) has pointed out that LCDs have been inconsistent and sometimes conflicting.

As a result, the Centers for Medicare and Medicaid Services (CMS) started an LCD modernization process.  CMS has revised the Medicare Program Integrity Manual (PIM), Chapter 13 – Local Coverage Determinations (Pub 100-08).

Above all, Medicare Administrative Contractors (or ‘MACs) have the authority and responsibility to develop LCDs for their jurisdictions.  To be clear, CMS also intends that LCDs are consistent between all MACs and all jurisdictions and expects that MACs meet and confer regarding these consistencies prior to publication of an LCD.

To explain, the new process is intended to provide greater transparency, consistency and patient engagement, as well as support larger CMS innovation initiatives. The revised PIM guides stakeholders by describing the process, what to expect, and how to provide feedback to MACs. It also clarifies CMS’s expectations for MACs.

For example, the new PIM provides the following component of its process before a Medicare LCD is finalized.

First, the new PIM states, “After the proposed LCD is made public, MACs shall hold open meetings to discuss the review of the evidence and the rationale for the proposed LCD(s)…”

Second, the new approach requires review “…with stakeholders in their jurisdiction. The open meeting should endeavor to accommodate some in-person attendance, subject to limitations based on venue.

And thrd, “Interested parties (generally those that would be affected by the LCD, including providers, physicians, vendors, manufacturers, beneficiaries, caregivers, etc.) can make presentations of information related to the proposed LCDs”

How Do you Find a Medicare LCD for Your Jurisdiction?

The Medicare Administrative Contractors are listed below as of October 2021 by State, Jurisdiction, and the name of the MAC:

 

State	Jurisdiction (J)	Medicare Administrative Contractor (MAC)
Medicare LCDs for Alabama	DME MAC – JC	Alabama DME MAC – JC is CGS Administrators, LLC
	A/B MAC – JJ	Palmetto GBA, LLC
	HH + H MAC – JM	Palmetto GBA, LLC
Medicare LCDs ForAlaska	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH+ H MAC – J6	National Government Services, Inc.
American Samoa	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JE	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Arizona	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Arkansas	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JH	Novitas Solutions, Inc.
	HH + H MAC – JM	Palmetto GBA, LLC
Medicare LCDs for California	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JE	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Colorado	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JH	Novitas Solutions, Inc.
	HH + H MAC – J15	CGS Administrators, LLC
Medicare LCDs for Connecticut	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JK	National Government Services, Inc.
	HH + H MAC – JK	National Government Services, Inc.
Delaware	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JL	Novitas Solutions, Inc.
	HH + H MAC – J15	CGS Administrators, LLC
District of Columbia	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JL	Novitas Solutions, Inc.
	HH + H MAC – J15	CGS Administrators, LLC
Florida Medicare Local Coverage Determinations	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JN	First Coast Service Options, Inc.
	HH + H MAC – JM	Palmetto GBA, LLC
Georgia	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JJ	Palmetto GBA, LLC
	HH + H MAC – JM	Palmetto GBA, LLC
Guam	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JE	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Medicare LCDs for Hawaii	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JE	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Idaho Medicare LCDs	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Illinois	DME MAC – JB	CGS Administrators, LLC
	A/B MAC – J6	National Government Services, Inc.
	HH + H MAC – JM	Palmetto GBA, LLC
Indiana	DME MAC – JB	CGS Administrators, LLC
	A/B MAC – J8	Wisconsin Physicians Service Government Health Administrators
	HH + H MAC – JM	Palmetto GBA, LLC
Iowa	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – J5	Wisconsin Physicians Service Government Health Administrators
	HH + H MAC – J15	CGS Administrators, LLC
Kansas	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – J5	Wisconsin Physicians Service Government Health Administrators
	HH + H MAC – J15	CGS Administrators, LLC
Kentucky	DME MAC – JB	CGS Administrators, LLC
	A/B MAC – J15	CGS Administrators, LLC
	HH + H MAC – JM	Palmetto GBA, LLC
Louisiana	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JH	Novitas Solutions, Inc.
	HH + H MAC – JM	Palmetto GBA, LLC
Maine	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JK	National Government Services, Inc.
	HH + H MAC – JK	National Government Services, Inc.
Medicare LCDs for Maryland	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JL	Novitas Solutions, Inc.
	HH + H MAC – J15	CGS Administrators, LLC
Medicare LCDs for Massachusetts	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JK	National Government Services, Inc.
	HH + H MAC – JK	National Government Services, Inc.
Michigan	DME MAC – JB	CGS Administrators, LLC
	A/B MAC – J8	Wisconsin Physicians Service Government Health Administrators
	HH + H MAC – J6	National Government Services, Inc.
Minnesota	DME MAC – JB	CGS Administrators, LLC
	A/B MAC – J6	National Government Services, Inc.
	HH + H MAC – J6	National Government Services, Inc.
Mississippi	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JH	Novitas Solutions, Inc.
	HH + H MAC – JM	Palmetto GBA, LLC
Missouri	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – J5	Wisconsin Physicians Service Government Health Administrators
	HH + H MAC – J15	CGS Administrators, LLC
Montana	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J15	CGS Administrators, LLC
Nebraska	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – J5	Wisconsin Physicians Service Government Health Administrators
	HH + H MAC – J15	CGS Administrators, LLC
Nevada	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JE	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
New Hampshire	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JK	National Government Services, Inc.
	HH + H MAC – JK	National Government Services, Inc.
New Jersey	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JL	Novitas Solutions, Inc.
	HH + H MAC – J6	National Government Services, Inc.
New Mexico	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JH	Novitas Solutions, Inc.
	HH + H MAC – JM	Palmetto GBA, LLC
New York Medicare LCDs	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JK	National Government Services, Inc.
	HH + H MAC – J6	National Government Services, Inc.
North Carolina Medicare LCDs	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JM	Palmetto GBA, LLC
	HH + H MAC – JM	Palmetto GBA, LLC
North Dakota Medicare LCDs	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J15	CGS Administrators, LLC
Northern Mariana Islands Medicare LCS	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JE	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Ohio Medicare Local Coverage Determinations	DME MAC – JB	CGS Administrators, LLC
	A/B MAC – J15	CGS Administrators, LLC
	HH + H MAC – JM	Palmetto GBA, LLC
Oklahoma Medicare LCDs	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JH	Novitas Solutions, Inc.
	HH + H MAC – JM	Palmetto GBA, LLC
Oregon Medicare Coverage Determinations	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Medicare LCDs for Pennsylvania	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JL	Novitas Solutions, Inc.
	HH + H MAC – J15	CGS Administrators, LLC
Medicare LCDs for Puerto Rico	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JN	First Coast Service Options, Inc.
	HH + H MAC – J6	National Government Services, Inc.
Rhode Island	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JK	National Government Services, Inc.
	HH + H MAC – JK	National Government Services, Inc.
Medicare LCDs for South Carolina	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JM	Palmetto GBA, LLC
	HH + H MAC – J M	Palmetto GBA, LLC
South Dakota	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J15	CGS Administrators, LLC
Tennessee	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JJ	Palmetto GBA, LLC
	HH + H MAC – JM	Palmetto GBA, LLC
Medicare LCDs for Texas	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JH	Novitas Solutions, Inc.
	HH + H MAC – JM	Palmetto GBA, LLC
Utah Medicare LCDs	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J15	CGS Administrators, LLC
Vermont Medicare LCDs	DME MAC – JA	Noridian Healthcare Solutions, LLC
	A/B MAC – JK	National Government Services, Inc.
	HH + H MAC – JK	National Government Services, Inc.
Medicare LCDs for Virgin Islands	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JN	First Coast Service Options, Inc.
	HH + H MAC – J6	National Government Services, Inc.
Virginia	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JL	Novitas Solutions, Inc.
	(includes Part B for counties of Arlington and Fairfax, and the city of Alexandria)
	A/B MAC – JM	Palmetto GBA, LLC
	(excludes Part B for the counties of Arlington and Fairfax, and the city of Alexandria)	CGS Administrators, LLC
	HH + H MAC – J15
Medicare LCDs for Washington	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J6	National Government Services, Inc.
Medicare LCDs for West Virginia	DME MAC – JC	CGS Administrators, LLC
	A/B MAC – JM	Palmetto GBA, LLC
	HH + H MAC – J15	CGS Administrators, LLC
Wisconsin Medicare Local Coverage Determinations	DME MAC – JB	CGS Administrators, LLC
	A/B MAC – J6	National Government Services, Inc.
	HH + H MAC – J6	National Government Services, Inc.
Medicare LCDs for Wyoming	DME MAC – JD	Noridian Healthcare Solutions, LLC
	A/B MAC – JF	Noridian Healthcare Solutions, LLC
	HH + H MAC – J15	CGS Administrators, LLC

 

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