Skip to Main Content

Print | Bookmark | Font Size: + |

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 13External PDF for details about the LCD process.

CGS Resources

How to Find CGS J15 LCDs & Articles

NOTE: CMS and MACs don't develop an NCD or LCD for each item or service that Medicare covers. In the absence of a national or local coverage policy, reference the Social Security Act, CMS Medicare Benefit Policy Manual (Pub. 100-02)External Website, Code of Federal Regulations, and CMS or CGS websites for coverage guidance.

ID Title Effective Date Revision Effective Date Last Updated Status HCPCS/CPT Code Article(s)
L34538External Website Hospice Determining Terminal Status 10/1/2015 6/27/2024 7/11/2024 Active N/A N/A
L33942External Website Physical Therapy – Home Health 10/1/2015 6/27/2024 7/11/2024 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 HealthExternal Website
N/A Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage – Medical Policy Article 10/1/2015 6/30/2025 4/8/2025 Future See the Coding Information section in the article A52527 – Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage – Medical Policy ArticleExternal Website

Updated: 04.21.2025

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved