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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. For additional information on the LCD process, please reference the CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 13External PDF.

How to Find CGS' LCDs

CMS and MACs use the Medicare Coverage Database (MCD)External Website to maintain all National Coverage Determinations (NCDs) and LCDs. The CMS MCD ArchiveExternal Website contains outdated (no longer in effect) LCDs and articles.

For your convenience, the table below includes direct links to CGS' active and future LCD policies and their related billing and coding articles.

An NCD/LCD policy does not exist for every item or service that Medicare covers. You should also reference the Social Security Act, CMS Medicare Benefit Policy Manual (Pub. 100-02)External Website, Code of Federal Regulations and/or other CMS/CGS resources (such as the guidelines below) to determine coverage guidance.

ID Title Effective Date Revision Effective Date Last Updated Status HCPCS/CPT Code Related Article(s)
L34538External Website Hospice Determining Terminal Status 10/1/2015 7/6/23 6/28/23 Active N/A N/A
L33942External Website Physical Therapy – Home Health 10/1/2015 7/6/23 6/28/23 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

Updated: 01.19.24

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