Local Coverage Determinations: Find Them Quickly

Published 06/09/2020

Local Coverage Determinations (LCDs) contain specific information guidelines about how Palmetto GBA covers some procedures.

  • The basis for LCDs is Section 1862 (a)(1)(A) of the Social Security Act
  • The Centers for Medicare & Medicaid Services (CMS) provides guidance to all Medicare contractors regarding LCDs in the Program Integrity Manual (Pub. 100-08), chapter 13, section 13.1.3

We encourage you to locate and become familiar with LCDs before submitting services for which an LCD may apply. Use the CMS Medicare Coverage Database directly to locate a LCD or related article.

Knowing about coverage restrictions in advance will ensure that you can help your patients make informed decisions and enable you to submit accurate claims.

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