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 13.
How to Find CGS' LCDs
CMS and MACs use the Medicare Coverage Database (MCD) to maintain all National Coverage Determinations (NCDs) and LCDs. The CMS MCD Archive
contains outdated (no longer in effect) LCDs and articles.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), 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 | HCPC/CPT Code | Related Policy Article(s) |
---|---|---|---|---|---|---|---|
L34538![]() |
Hospice Determining Terminal Status | 10/1/2015 | 7/6/23 | 6/28/23 | Active | N/A | N/A |
L33942![]() |
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 Health![]() |
Updated: 07.25.23