LOCAL COVERAGE DETERMINATION (LCD)

local-coverage-determination-lcd

What is LOCAL COVERAGE DETERMINATION (LCD)?

LOCAL COVERAGE DETERMINATION (LCD) meaning An LCD, as established by Section 522 of the Benefits Improvement and Protection Act, is a decision by a Medicare Contractor (A/B MAC, DME MAC, HHH MAC, Fiscal Intermediary or Carrier) whether to cover a particular service or item on an contractor-wide basis in accordance with Section 1862(a)(1)(A) of the Social Security Act (i.e., a determination as to whether the service is reasonable and necessary). The difference between LMRPs and LCDs is that LCDs consist only of “reasonable and necessary” information, while LMRPs frequently also contained benefit category or statutory provisions.For a full description of the process and criteria used in developing LCDs, refer to Chapter 13 of the Medicare Program Integrity Manual.

 

reference: Centers for Medicare & Medicaid Services

Tags: