- ABN Modifiers
- American Medical Association and Current Procedural Terminology
- CMS Forms and Publications
- CMS Regional Offices
- Clinical Lab Improvement Amendment
- Comprehensive Error Rate Testing
- Electronic Health Records
- Electronic Prescribing
- Evaluation and Management Documentation Guidelines
- Federal Register
- Health Insurance Portability and Accountability Act of 1996
- Interactive Voice Response System
- Limitation of Liability (Advance Beneficiary Notice of Noncoverage)
- Local Coverage Determination
- Medically Unlikely Edits
- Medicare Coverage Database
- Medicare Electronic Data Interchange
- Medicare Fraud and Abuse
- Medicare Learning Network®
- Medicare Provider-Supplier Enrollment with NGS
- NGS Internet Resources
- NGSConnex Online Web Application Can Save Time and Money
- NGS Check Provider Enrollment Application Status Tool
- National Correct Coding Initiative
- National Coverage Determination
- National ICD-10-CM-PCS: The Next Generation of Coding
- National Provider Calls and Events
- National Provider Identifier
- National Provider Identifier Registry
- National Uniform Claim Committee
- Open Door Forums
- P.O. Box Mailing Addresses
- Patient Protection and Affordable Care Act of 2010
- Physician Quality Payment Program
- Provider Contact Center
- Provider Enrollment
- Reconsideration (Second Level of Appeal)
- Recovery Audit Program
- Redetermination (First Level of Appeal)
- Skilled Nursing Facility Consolidated Billing
- U.S. Government Printing Office
- Washington Publishing Company
Local Coverage Determination
LCDs are developed by the local Medicare contractor in the absence of a national Medicare payment policy. These policies describe specific criteria which determine whether an item or service is covered by Medicare and under what circumstances. LCDs are updated as new information and technology occurs in the field of medicine. National Government Services has LCDs providing guidelines for various types of services.
A local policy may consist of two separate, though closely related documents: the LCD and the billing and coding article. The LCD only contains reasonable and necessary language. Any unreasonable and necessary language a Medicare contractor wishes to communicate to providers may be done through the billing and coding article. At the end of an LCD that has an associated article, there is a link to the related article and vice versa.
National Government Services has an LCD Reconsideration Process by which interested parties can request a revision to an LCD.
Please refer to Medical Policy Article A52842. The medical policies and related articles can be found on our Medical Policies web page.
The LCD Reconsideration Process is available only for final LCDs. The whole LCD or any part of the LCD may be reconsidered.
LCD Reconsideration requests are not accepted for other documents including:
- NCDs (for example, Medicare Coverage Issues Manual policies)
- Coverage provisions in interpretive manuals (for example, instructions found in the Medicare Hospital Manual);
- Draft LCDs;
- Template LCDs, unless or until they are adopted by the contractor;
- Retired LCDs;
- Individual claim determinations;
- Bulletins, articles, training materials; and
- Any instance in which no LCD exists (for example, requests for development of an LCD).
Qualified parties who request LCD reconsideration must submit a written request that includes the following items:
- name and address;
- telephone number (optional);
- email address (if applicable);
- name and address of the organization he/she represents and the nature of that organization's business if the requestor is neither a beneficiary nor a provider; and
- the name of the LCD.
Contact the Medical Policy Unit at NGS.lcd.reconsideration@anthem.com for questions concerning reconsideration of an active LCD.
Note
- Justification supported by new evidence, which may materially affect the LCD's content or basis, is required for all LCD reconsideration requests, including those made by email and fax.
- These requests should not include any PHI and/or PII.
NGS LCDs can be found on the Medical Polices page on our website.
You may also access the LCD on the CMS Medicare Coverage Database.
The CMS Medicare Coverage Database: Advanced Search feature allows you to search by additional filters including ICD-9 and ICD-10 codes.
Revised 10/21/2024