Application of Local Medical Review Policies (Rev. 866, 07-03-06) - Competitive Acquisition Program

by  Jared Staheli
July 9th, 2015

Carriers and/or Program Safeguard Contractors shall apply all Local Coverage Determination (LCD) policies and National Coverage Determination (NCD) policies to the administration and no-pay drug code lines on the CAP claims.

Should it be determined that a drug administration or drug code service line does not meet the requirements of the LCD, the carrier shall follow current processes to determine how to adjudicate the related services.

If appropriate, the carriers shall include messages on the MSN and RA to indicate which LCD was applied.

The carriers shall also apply all regular edits to the administration and no-pay drug lines and send appropriate denial messages.


Application of Local Medical Review Policies (Rev. 866, 07-03-06) - Competitive Acquisition Program. (2015, July 9). Find-A-Code Articles. Retrieved from

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)

Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
free demo
request yours today
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.