by Aimee Wilcox, CPMA, CCS-P, CST, MA, MT
January 23rd, 2018
Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. They provide guidance related to specific medical services and procedures and identify whether or not they are medically necessary and a covered benefit by Medicare.
Where an NCD may provide only generalities about a procedure or service, or where one does not exist, Medicare Administrative Contractors (MACs) may create, and implement, Local Coverage Determinations (LCDs) to provide further detail and guidance.
Although an NCD or LCD may not have been created for every single procedure or service, Find-A-Code has identified those that do exist, and has linked them to the CPT and HCPCS codes they apply so our subscribers can easily access that important coding guidance.
There are two ways in which to locate NCDs in Find-A-Code:
- Using any of our Find-A-Code search methods, look up a CPT or HCPCS code and scroll down to the “Medicare Policies & Guidelines (NCDs, LCDs, Articles).” Click to open the tab, which will identify the number of
NCDs(5) or LCDs (2) associated with the code you searched on. Simply click on the NCD link to view the details of the document.
- A listing of all NCDs can be done from the Find-A-Code home page. Hover over the Info page (as seen in the graphic below), and under the section, “Medicare Manuals and Guides,” click on “NCDs National Coverage.” A list will appear identifying each NCD by a numerical value, which can be opened and perused at your convenience.