By recei Local coverage determination (LCD)
It is the responsibility of Medicare Administrative Contractor (MAC) to set guidelines whether a service or item can be reimbursed, it is known as a local coverage determination (LCD). It is always based on medical necessity and is valid only in the contractor’s designated region. For example, if you are a healthcare provider based in Illinois, an administrative contractor called “CGS Administrators LLC” determines your LCD, i.e., the conditions of payment for the services that you render.
L35755–Non-Invasive Abdominal / Visceral Vascular Studies.
National Coverage Determination (NCD)
The Centers for Medicare and Medicaid Services make a decision on whether to cover a certain procedure or not. It is called as National Coverage Determination (NCD). NCD covers the services that are not mentioned in a regional LCD. It is applicable nationwide in the US to specify the Medicare coverage of certain services. All Medicare contractors ought to follow the NCDs.
It is important that all professionals like medical coders and billers follow the guidelines established for Medicare coverage of a certain procedure or service.
important websites–CMS
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