by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
December 4th, 2014
What are NCDs and LCDs?
NCD — NATIONAL COVERAGE DETERMINATIONS
Medicare specific coverage on the national level. All Medicare carriers are required to follow the NCDs. The NCDs are developed by CMS to describe the circumstances for Medicare coverage nationwide for an item or service. NCDs generally outline the conditions for which an item or service is considered to be covered (or not covered). NCDs are usually issued as a program instruction. Once published in a CMS program instruction, an NCD is binding on all Medicare carriers.
LCD — LOCAL COVERAGE DETERMINATIONS
LCDs are always based on medical necessity and created by a carrier whether to cover a particular service. They only apply to the area served by the contractor who made the decision. LCDs determine as to whether the service or item is reasonable or necessary. Medicare contractors develop LCDs when there is no National Coverage Determination (NCD) or when there is a need to further define an NCD.
If an NCD or LCD does not specifically spell out the list of codes, it does not apply to the rule.