tci Part B Insider - 2013 Issue 4

Reader Question: Local Coverage Decisions Trump NCDs

Question: Our local MAC has a policy stating that only physicians can perform a particular service, but the national coverage decision for that same service says that non-physician practitioners can perform it as well. Do we follow the local coverage decision or the national one? Answer: You should follow the local coverage decision (LCD), CMS reps advised during a Jan. 29 Open Door Forum. "National policies would represent policy in the absence of a local coverage decision," the CMS rep said. "If the local contractor sends out a more restrictive policy, that would be their prerogative." ...

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