Understanding and Applying Medicare's NCD's and LCD's

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Description of the topic: 

The Medicare Carrier system is divided into geographical areas in which different carriers are contracted to adjudicate claims for Medicare Part A and B patients.  NCD’s are National Coverage Determinations that give direction on billing and coding for certain procedures that apply to all providers in any geographical area.  There is also a spreadsheet which for each NCD that describes the payable ICD-10-CM codes for the procedures in the policy, if applicable, along with other information needed for correct claims submission.  In the absence of a NCD, a Local Coverage Determination, or LCD, may be created by a particular Medicare carrier for Part A or B benefits on a particular or group of procedures and/or services.  The NCD would only apply to those states that are listed on the NCD, and cannot be applied claims for other jurisdictions.  This can complicate things as one state may cover a service or procedure for a particular reason, but the next state may not.  This webinar will show attendees how to locate the appropriate NCD’s and LCD’s for their area, and give direction on how to use the information in the policies.


The Center for Medicare and Medicaid Services (CMS) have different methods of sharing and publishing their policies and guidelines.  Two of those methods are National Coverage Determinations (NCD), and Local Coverage Determinations (LCD).

Why should you attend?

Anyone who is involved in the documenting, coding, and billing should understand where to find these guidelines and what can be found in the policies.  Medicare only covers services and procedures that are considered medically necessary.  There are circumstances in which a provider may feel that something is needed for the diagnosis or treatment of a patient, however, Medicare does not feel that the patient meets their criteria for medical necessity, and so the claim is denied.  A patient can be held responsible if they are notified in advance that they may be responsible, and they sign an Advanced Beneficiary Notice (ABN).  NCD’s and LCD’s assist in knowing what conditions and/or problems are considered payable for a procedure or service. 


Areas Covered in the Session:

  • Locating NCD’s on the Center for Medicare and Medicaid Services (CMS) website
  • Utilize the information on the NCD spreadsheet to determine coverage for medical necessity
  • Learn how to receive information when policies are updated
  • Look up LCD’s for your state
  • Dissect an LCD explaining the different pieces of information
  • Discovering LCD articles that give further detailed instructions on application of an LCD

Who will benefit: 

biller, coder, manager, administrator, insurance collector, Medicare specialist. 

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Get in touch

(315) 632-0735,
(315) 750-4379