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.
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)
, Code of Federal Regulations, and CMS or CGS websites for coverage guidance.
- Home Health Coverage Guidelines
- Hospice Coverage Guidelines
- Search the Medicare Coverage Database (MCD)
(includes all national and local coverage policy document types) or MCD Archive
(contains outdated (no longer in effect) LCDs and articles). See MCD Help & Resources
for details. - Use the direct links to CGS J15 active and future LCDs and articles provided in the table below.
- Search the Medicare Coverage Database (MCD)
| ID | Title | Effective Date | Revision Effective Date | Last Updated | Status | HCPCS/CPT Code | Article(s) |
|---|---|---|---|---|---|---|---|
| L34538 |
Hospice Determining Terminal Status | 10/1/2015 | 8/7/2025 | 7/29/2025 | Active | N/A | N/A |
| L33942 |
Physical Therapy Home Health | 10/1/2015 | 8/7/2025 | 7/29/2025 | 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, 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 | 10/1/2015 | 7/1/2025 | 6/16/2025 | Active | See the Coding Information section in the article | A52527 – Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage Medical Policy Article |
Updated: 10.24.2025

