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Local Versus National Medicare Coverage

The Medicare statute states that items and services provided to beneficiaries must be "reasonable and necessary" to be covered for reimbursement to physicians, hospitals, and other providers. Although the Medicare program may determine in specific cases whether a particular item or service was reasonable and necessary, it also issues policies, called coverage determinations, to instruct carriers and other intermediaries regarding reimbursement to providers.

Local coverage determinations (LCDs) are still more common than national coverage determinations (NCDs), although national policies are now issued more often than in the past.

The principal function of an LCD is to advise providers and practitioners . . . [Click for More]