Glossary / LCD
LCD Local Coverage DeterminationLCD (Local Coverage Determination)
A MAC's published coverage policy for an item, listing the clinical criteria a claim must meet; for DME the LCDs are joint across all four DME MACs.
A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor about whether an item or service is reasonable and necessary, and under what conditions, within that contractor's jurisdiction. The term is defined in Section 1869(f)(2)(B) of the Social Security Act. LCDs are limited to reasonable-and-necessary criteria; the coding and billing instructions that used to sit inside them now live in separate billing and coding articles.
The DME MACs write their LCDs jointly, so the same policy applies in all four jurisdictions. Each equipment category has one: Positive Airway Pressure Devices (L33718), Oxygen and Oxygen Equipment (L33797), Respiratory Assist Devices (L33800), Hospital Beds and Accessories (L33820), Manual Wheelchair Bases (L33788), and Power Mobility Devices (L33789), among others. All are searchable in the Medicare Coverage Database.
The LCD is where the numbers come from: the AHI threshold for CPAP, the blood-gas values for oxygen, the positioning criteria for a hospital bed. A reviewer handling an ADR or a PA request checks the record against the LCD and its policy article, so the LCD is the primary source for any documentation checklist.
Common questions
How is an LCD different from an NCD?
An NCD is issued by CMS and applies nationally, binding every MAC. An LCD is issued by a MAC and applies only in its jurisdiction, and only where no NCD settles the question.
Where do I find the current LCD for an item?
The Medicare Coverage Database on cms.gov. Search by the L-number or the HCPCS code, and read the related billing and coding article alongside it.
Do AffirmDME's checklist items cite the LCD?
Yes. Each readiness item carries the citation it mirrors, whether that is a CFR section, an LCD, or a policy article.
Related
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Sources: CMS: Medicare Coverage Determination Process · CMS Medicare Coverage Database . Definitions summarize public Medicare policy and are not legal or billing advice.
More terms
- ADR — Additional Documentation Request
- Prior authorization
- Affirmation and non-affirmation
- UTN — Unique Tracking Number
- SWO — Standard Written Order
- Face-to-face encounter
- DME MAC — Durable Medical Equipment Medicare Administrative Contractor
- Jurisdiction
- PTAN — Provider Transaction Access Number
- NPI — National Provider Identifier
- MBI — Medicare Beneficiary Identifier
- NCD — National Coverage Determination
- Policy article
- HCPCS — Healthcare Common Procedure Coding System
- Length of need
- Prior authorization exemption
- Competitive bidding
- CMN and DIF — Certificate of Medical Necessity and DME Information Form
- Proof of delivery
- TPE — Targeted Probe and Educate
- Prepayment review