The Centers for Medicare and Medicaid Services (CMS) has directed Fiscal Intermediaries (FIs) to develop coverage decisions for services that are not governed by Medicare regulations, national coverage, payment and coding policies to provide guidance to the public and medical community. These coverage decisions developed by the FI are called Local Coverage
Determinations (LCDs). In addition, LCDs may be adopted from Noridian, Medicare Part B (carrier) or developed by BCBS of AZ Medicare Part A, utilizing research, input from physicians, representatives of the provider and the medical community. In the event that a National Coverage Determination (NCD) is established for any of the LCDs, the national coverage will be published and take precedence over the local coverage.
A comment and notice period is unnecessary in the following
situations:
A revised LCD that liberalizes an existing LCD.
A revised LCD is being issued for compelling reasons.
A revised LCD that makes a non-substantive correction.
A revised LCD that makes a clarification.
A revised LCD that makes a non-discretionary coverage/payment/coding
update(s).
A revised LCD to make discretionary coding updates that do
not restrict.
A revised LCD to effectuate an administrative law judge’s
decision on a BIPA 522 challenge.
A list of our Local Coverage Determinations (LCDs) will be
posted online for your easy access here.
We will continue to provide valuable information regarding
the LCDs via this website, so please check back often.
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