Medicare Local Coverage Determinations and the Impact on Patient Care

Medicare is a complex system and decisions made by Medicare often are used by insurance carriers when they are determining how they will cover specific healthcare services. A National Coverage Determination (NCD) is the means of communication Medicare utilizes to inform participating providers and facilities about services that will be covered at a national level. There are times when the treatment or therapy being prescribed for a patient is not covered by a NCD. If you find yourself in this situation, you may have another avenue to access treatment coverage for your patient-- a Local Coverage Determination (LCD). The Fiscal Intermediaries (FI) and Medicare Administrative Contractors (MACs) are able to develop LCD’s when there is a need to further define a National Coverage Determination.₁

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