National and Local Coverage Determinations (NCDs and LCDs)
An NCD sets forth the extent to which Medicare will cover specific services, procedures, or technologies on a national basis. If an NCD does not specifically exclude/limit an indication or circumstance, or if the item or service is not mentioned at all in an NCD or in a Medicare manual, then an LCD may be in place to offer guidance.
NCDs are published by The Centers for Medicare & Medicaid Services (CMS), and become effective as of the date listed in the transmittal that announces the manual revision.
NCDs can be found in the Medicare National Coverage Determinations Manual (Pub. 100-03)
LCDs are published by each Medicare Administrative Contractor (MAC). These policies are for further guidance on determining medical necessity of services.
LCDs are frequently published on issues which have been seen as having a high error rate and needing further guidance and clarification.
LCDs are located on the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database Web page. Access CGS's active and retired LCDs for home health providers through the CMS Local Coverage DeterminationWeb page.
Updated: 07.30.12