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Local Coverage Determination Retirement

An LCD is a policy decision made by a MAC concerning whether to allow coverage of a particular item or service.

The Centers for Medicare & Medicaid Services, Internet-Only Manual Publication 100-08, Medicare Program Integrity Manual, Chapter 13 - Local Coverage Determinations provides the general instructions that all MACs follow to develop and implement LCDs and associated billing and coding Articles (also referred to as Medical Policy articles). When there is both an LCD and a billing and coding article for an item or service, you should reference both documents to obtain a full understanding of coverage, billing and documentation requirements.

As your MAC, National Government Services notifies our providers via listserv messaging of all final LCD-related decisions including new, revised, or retired LCDs and related articles. In addition, we include information on recently retired LCDs and associated billing and coding articles in the Medical Policy section of our website. NGS archives a retired LCD for a minimum of six years and three months from the date the LCD is retired.

While in effect, our LCDs and any associated billing and coding articles apply to all applicable services billed to us with DOS that fall within the LCD and the article’s effective dates. Note: LCDs and articles authored by other MACs do not apply to services rendered in our MAC jurisdictions.

MACs have discretion to revise or retire an LCD and/or billing and coding article at any time. An LCD may be retired due to various reasons including: 

  • Low utilization
  • Outdated technology
  • Considered a standard of care
  • Services addressed in a NCD, a coverage provision in a CMS interpretative manual or an article.

A retired LCD is no longer valid for processing claims received for DOS rendered after the LCD’s retirement date. When there is no current LCD, it does not mean that the item or service is automatically covered or non-covered. Rather, Medicare coverage is determined based upon whether the item or service falls under the “reasonable and medically necessary” guidelines and is documented as such. When there is no current LCD, you should review relevant coverage guidelines including:

Post Payment Review

Medicare payment does not necessarily mean that the service was medically necessary and/or correctly billed. We may conduct post-payment review on previously paid claims. If so, we consider all policies, medical necessity, and correct billing guidelines that were in place at the time the services were rendered. Our post-payment review includes LCDs and NCDs as well as associated articles that were in effect when the services were rendered.

Revised 10/11/2024