LCDs / Medical Policies
A Local Coverage Determination (LCD), as defined in §1869(f)(2)(B) of the Social Security Act (SSA), is a Medicare Administrative Contractor's (MAC's) determination as to whether a particular item or service is covered on a contractor-wide basis in accordance with §1862(a)(1)(A) of the Act.
Reference the CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 13 for details about the LCD process.
How to Find CGS J15 LCDs & Articles
NOTE: CMS and MACs don't develop an NCD and/or LCD for each item or service that Medicare covers. In the absence of a national/local coverage policy, reference the Social Security Act, CMS Medicare Benefit Policy Manual (Pub. 100-02), Code of Federal Regulations, and/or other CMS/CGS resources for coverage guidance.
- Search the Medicare Coverage Database (MCD) (includes all national/local coverage policy related document types) or the MCD Archive (contains outdated (no longer in effect) LCDs and articles). See the How to Use the Medicare Coverage Database MLN educational tool for details.
- Use the direct links to CGS J15 active and future LCDs and articles provided in the table below.
ID | Title | Effective Date | Revision Effective Date | Last Updated | Status | HCPCS/CPT Code | Article(s) |
---|---|---|---|---|---|---|---|
L34538 | Hospice Determining Terminal Status | 10/1/2015 | 6/27/24 | 7/11/24 | Active | N/A | N/A |
L33942 | Physical Therapy – Home Health | 10/1/2015 | 6/27/24 | 7/11/24 | Active | Group 1: G0151 Group 2: 95851, 95852, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97110, 97112, 97113, 97116, 97124, 97140, 97161, 97162, 97163, 97164, 97530, 97535, 97542, 97750, 97755, 97760, 97761, 97763, G0281, G0283, G0329 Group 3: 98966, 98967, 98968, 98970, 98971, 98972, 98975, 98976, 98977, 98980, 98981, G2010, G2012, G2250, G2251 |
A57311 – Billing and Coding: Physical Therapy – Home Health |
N/A | Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage – Medical Policy Article | 10/1/15 | 6/30/24 | 5/9/24 | Active | See the Coding Information section in the article | A52527 – Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage – Medical Policy Article |
Updated: 07.29.24