How to Find a Local Coverage Determination
As the MAC for J6 and JK, NGS is responsible for posting and maintaining LCDs and articles for many Medicare billed services. These LCDs and articles can be found at the Medical Policy Center.
Please Note: There are many procedures for which NGS does not have an LCD or article.
If you do not find a coverage document on a procedure in our Medical Policy Center, then it may not have a local determination. Title XVIII of the Social Security Act section 1862 (a)(1)(A applies to all billed services, i.e., coverage and payment of those services must be considered to be medically reasonable and necessary.
An LCD is a determination by the MAC that defines coverage criteria for a particular service within its jurisdiction. The LCD consists of indications and limitations of coverage. The related billing and coding article includes CPT/HCPCS codes, ICD-10 codes and documentation guidelines that support the LCD.
Each LCD and article listing in our index includes the CPT/HCPCS codes that are covered by these documents.
Medical Policy Center Example
| LCD | LCD # | Billing and Coding # | Response to Comments | Related CPT/HCPCS Codes |
| Autonomic Function Testing Related terms: tilt table, sudomotor |
L36236 | A57024 | A54403 | 95921, 95922, 95923, 95924, 95943 |
| Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis Related terms: N/A |
L37733 | A56609 | A56742 | 81539, 84153, 84154, 86316, 81479, 0005U |
Posted 8/26/2020