Local Medical Review Policy (LMRP) Information

Retirement of LMRPs

The final rule establishing LCDs was published November 11, 2003. Effective December 7, 2003, CMS's Medicare contractors began issuing LCDs instead of LMRPs. Over the next 2 years (until December 31, 2005) contractors updated and converted all existing LMRPs into LCDs and Articles.

Note:  Effective Jan 2019, much of the coding information is being pulled out of LCDs and being put into Articles.

Definition of an LMRP

An LMRP is a Local Medical Review Policy. LMRPs are the coverage policies that are developed by the Medicare Insurance Carriers and apply directly to claims made to the Insurance Carrier for Coverage under Medicare. LMRPs outline how local carriers will review claims to ensure that they meet Medicare coverage and coding requirements. They specify under what clinical circumstances a service is covered and correctly coded. An LMRP includes a description of the service, specific procedure codes, and for each of these procedures, a list of covered and non-covered diagnostic codes.

LMRPs are issued separately for types of medical services, including Psychiatry and Psychological Services, so hundreds of LMRPs are in existence for each local carrier. In general, carriers have wide freedom to determine coverage; the only restriction is that their policies not directly conflict with a National Coverage Decision issued by CMS on the same issue.

Source: APA Online

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