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Submission: On May 10 via manual from US — Scanned from DE
Submission: On May 10 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST ./
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<input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE"
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<option value="s10">District of Columbia</option>
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<option value="s22">Kentucky</option>
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<option value="s24">Massachusetts</option>
<option value="s27">Michigan</option>
<option value="s28">Minnesota</option>
<option value="s31">Mississippi</option>
<option value="s29">Missouri</option>
<option value="s32">Montana</option>
<option value="s36">Nebraska</option>
<option value="s40">Nevada</option>
<option value="s37">New Hampshire</option>
<option value="s38">New Jersey</option>
<option value="s39">New Mexico</option>
<option value="s63">New York - Downstate</option>
<option value="s41">New York - Entire State</option>
<option value="s64">New York - Queens</option>
<option value="s65">New York - Upstate</option>
<option value="s34">North Carolina</option>
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<option value="s60">Northern Mariana Islands</option>
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<option value="s45">Pennsylvania</option>
<option value="s46">Puerto Rico</option>
<option value="s47">Rhode Island</option>
<option value="s48">South Carolina</option>
<option value="s49">South Dakota</option>
<option value="s50">Tennessee</option>
<option value="s51">Texas</option>
<option value="s52">Utah</option>
<option value="s55">Vermont</option>
<option value="s54">Virgin Islands</option>
<option value="s53">Virginia</option>
<option value="s56">Washington</option>
<option value="s58">West Virginia</option>
<option value="s57">Wisconsin</option>
<option value="s59">Wyoming</option>
<option value="r1">CMS Region 1</option>
<option value="r2">CMS Region 2</option>
<option value="r3">CMS Region 3</option>
<option value="r4">CMS Region 4</option>
<option value="r5">CMS Region 5</option>
<option value="r6">CMS Region 6</option>
<option value="r7">CMS Region 7</option>
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<p>
<strong> Local coverage Articles are a type of educational document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines that complement a Local Coverage Determination (LCD).
</strong>
</p>
<p> MACs are Medicare contractors that develop LCDs and Articles along with processing of Medicare claims. </p>
<p> There are different article types: </p>
<p>
<strong>Billing and Coding articles</strong> provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Billing and Coding articles typically include CPT/HCPCS
procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which
the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered.
</p>
<p>
<strong>Response to Comment (RTC) articles</strong> list issues raised by external stakeholders during the Proposed LCD comment period.
</p>
<p>
<strong>Self-Administered Drug (SAD) Exclusion List articles</strong> list the CPT/HCPCS codes that are excluded from coverage under this category. The Medicare program provides limited benefits for outpatient prescription drugs. The
program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. CMS has defined "not usually self-administered" according to how the Medicare
population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare
beneficiaries who use the drug. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug.
</p>
<p>
<strong>Draft articles</strong> are articles written in support of a Proposed LCD. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. Articles are often related
to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. Article document IDs begin with the letter "A" (e.g., A12345). Draft articles have document IDs that begin with "DA" (e.g.,
DA12345).
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<p>
<strong> A Local Coverage Determination (LCD) is a decision made by a Medicare Administrative Contractor (MAC) on whether a particular service or item is reasonable and necessary, and therefore covered by Medicare within the specific
jurisdiction that the MAC oversees. </strong>
</p>
<p> MACs are Medicare contractors that develop LCDs and process Medicare claims. MACs develop an LCD when there is no national coverage determination (NCD) (e.g., when an item or service is new) or when there is a need to further define
an NCD for the specific region. </p>
<p> LCDs are specific to an item or service (procedure) and they define the specific diagnosis (illness or injury) for which the item or service is covered. LCDs outline how the contractor will review claims to ensure that the services
provided meet Medicare coverage requirements. </p>
<p> Before an LCD becomes final, the MAC publishes Proposed LCDs, which include a public comment period. </p>
<p> LCD document IDs begin with the letter "L" (e.g., L12345). Proposed LCD document IDs begin with the letters "DL" (e.g., DL12345). </p>
<p> The guidelines for LCD development are provided in Chapter 13 of the Medicare Program Integrity Manual. The Social Security Act, Sections 1869(f)(2)(B) and 1862(l)(5)(D) define LCDs and provide information on the process. </p>
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<p>
<strong> NCDs are national policy granting, limiting or excluding Medicare coverage for a specific medical item or service. These are developed and published by CMS and apply to all states. NCDs are made through an evidence-based
process, with opportunities for public participation. </strong>
</p>
<p> Medicare coverage is limited to items and services that are considered "reasonable and necessary" for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). An NCD sets forth the
extent to which Medicare will cover specific services, procedures, or technologies on a national basis. Medicare Administrative Contractors (MACs) are required to follow NCDs </p>
<p> If an NCD does not specifically exclude/limit an indication or circumstance, or if the item or service is not mentioned at all in an NCD or in a Medicare manual, an item or service may be covered at the discretion of the MAC based on
a Local Coverage Determination (LCD). LCDs cannot contradict NCDs, but exist to clarify an NCD or address common coverage issues. </p>
<p> Prior to implementation of an NCD, CMS must first issue a Manual Transmittal, CMS ruling, or Federal Register Notice giving specific directions to claims-processing contractors. That issuance, which includes an effective date and
implementation date, is the NCD. If appropriate, the Agency must also change billing and claims processing systems and issue related instructions to allow for payment. The NCD will be published in the Medicare National Coverage
Determinations Manual. An NCD becomes effective as of the date of the decision memorandum. </p>
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<p>
<strong>NCAs: National Coverage Analysis (NCA).</strong> When an NCD is under consideration, either a new review or a reconsideration, there are numerous documents that support the process. These documents are considered the NCA. They
include tracking sheets to inform the public of the issues under consideration and the status (i.e., Pending, Closed) of the review, information about and results of MEDCAC (formerly known as MCAC) meetings, Technology Assessments, and
Decision Memoranda that announce CMS's intention to issue an NCD. These documents, along with the compilation of medical and scientific information currently available, any FDA safety and efficacy data, clinical trial information, etc.,
provide the rationale behind the evidence-based NCDs.
</p>
<p>
<strong>CALs: Coding Analyses for Labs (CAL) is an abbreviated process, similar to the National Coverage Determination (NCD) process, for making changes to the coding component of the negotiated laboratory NCDs.</strong> The process is
used for adjusting the list of covered (or non-covered) ICD-10-CM diagnosis codes and coding guidance in the NCDs when there is a question regarding whether the code flows from the narrative indications in the NCD. A tracking sheet is
posted opening a CAL and a 30-day public comment period follows. A decision memorandum announcing and explaining the decision is posted following the comment period. Changes are implemented in the next available quarterly update of the
laboratory edit module. More details regarding the process can be found in 68 FR 74607.
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<p>
<strong>The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) process was established to provide independent guidance and expert advice to CMS on specific clinical topics. It is used to supplement CMS's internal
expertise and to ensure an unbiased and contemporary consideration of "state of the art" technology and science. </strong>
</p>
<p> The MEDCAC reviews and evaluates medical literature, reviews technology assessments, public testimony and examines data and information on the benefits, harms, and appropriateness of medical items and services that are covered under
Medicare or that may be eligible for coverage under Medicare. The MEDCAC judges the strength of the available evidence and makes recommendations to CMS based on that evidence. They advise CMS on whether specific medical items and
services are reasonable and necessary under Medicare law. They perform this task in an open and public forum. The MEDCAC is advisory in nature, with the final decision on all issues resting with CMS. MEDCAC members are valued for their
background, education, and expertise in a wide variety of scientific, clinical, and other related fields. In composing the MEDCAC, CMS was diligent in pursuing ethnic, gender, geographic, and other diverse views, and to carefully screen
each member to determine potential conflicts of interest. You can read more about the
<a href="view/medicare-coverage-document.aspx?MCDId=10" target="_blank">Factors CMS Considers in Referring Topics to the Medicare Evidence Development & Coverage Advisory Committee</a>. </p>
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<p>
<strong> Each National Coverage Determination (NCD) is supported by a comprehensive Technology Assessment (TA) process, which often focuses on the quality of the evidence for a given technology. </strong>
</p>
<p> Health care Technology Assessment is a multidisciplinary field of policy analysis that studies the medical, social, ethical and economic implications of the development, diffusion and use of technologies. For some NCDs, external TAs
are requested through the Agency for Health Research and Quality (AHRQ). </p>
<p> You can read about the <a href="view/medicare-coverage-document.aspx?MCDId=7" target="_blank">Factors CMS Considers in Commissioning External Technology Assessments</a>, which includes a description of the TA process and guiding
principles for selecting which topics are referred. </p>
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<strong> Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) procedure codes comprise the medical code set that identifies health care procedures, equipment, and supplies for claim submission
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<p> HCPCS Level I, also known as the CPT codes, are 5-character numeric codes maintained by the American Medical Association (AMA). The CPT codes are used primarily to identify medical services and procedures furnished by physicians and
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<p> HCPCS Level II are 5-character alphanumeric codes maintained by CMS (except D codes, which are maintained by the American Dental Association). They are used to identify various items and services that are not included in the CPT code
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<p> When a provider submits a bill to insurance for reimbursement, each service is described by a CPT or HCPCS code, which is matched to an ICD-10-CM or ICD-10-PCS diagnosis code. If the CPT/HCPCS and ICD-10-CM / ICD-10-PCS codes don't
align correctly with each other, payment may be rejected. Local Coverage Articles, authored by the Medicare Administrative Contractors (MACs), include these codes and, when paired with the related Local Coverage Determination (LCD),
outline what is and is not covered by Medicare. </p>
<p> On the Medicare Coverage Database (MCD) you can use CPT/HCPCS codes to search for documents. Results will return Billing and Coding Articles or other documents that include the specified code. (Note: Sometimes an EOB or MSN may
display the CPT/HCPCS code with an associated modifier, which is represented by a dash and two characters. Examples: 76942-26 and 98941-GA. Occasionally, multiple modifiers may be listed together (e.g., A5514-RTKX). When searching the
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<strong> International Classification of Diseases, Revision 10, Clinical Modification (ICD-10-CM) is a medical classification list by the World Health Organization used by physicians and other healthcare providers to classify and code
all diagnoses recorded in conjunction with medical care in the United States. </strong> ICD-10-CM is the standard transaction code set for diagnostic purposes under the Health Insurance Portability and Accountability Act (HIPAA).
These codes ensure that a patient gets proper treatment and is charged appropriately for any medical services received.
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<p> ICD-10-CM contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. In the base classification, the code set allows for more than 72,000 different
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<p> The CMS ICD-10 Procedure Coding System (ICD-10-PCS) is a catalog of procedural codes used by medical professionals for hospital inpatient healthcare settings. The Centers for Medicare and Medicaid Services in tandem with the National
Center for Health Statistics, maintain the catalog in the U.S. releasing yearly updates. ICD-10-PCS codes have a structure of 7 alphanumeric characters and contains no decimals. The first character defines the major "section". Depending
on the "section" the second through seventh characters mean different things. </p>
<p> When a provider submits a bill to insurance for reimbursement, each service is described by a current procedural terminology (CPT) or healthcare common procedure code system (HCPCS) code, which is matched to an ICD-10-CM or ICD-10-PCS
code. If the CPT/HCPCS and ICD-10-CM / ICD-10-PCS codes don't align correctly with each other, payment may be rejected. Local Coverage Articles, authored by the Medicare Administrative Contractors (MACs), include these codes and, when
paired with the related Local Coverage Determination (LCD), outline what is and is not covered by Medicare. </p>
<p> On the Medicare Coverage Database (MCD) you can use ICD-10-CM codes to search for documents. Results will return Billing and Coding Articles or other documents that include the specified code. </p>
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<li>how</li>
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<h2 class="ama-indent">LICENSE FOR USE OF PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT")</h2>
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<b>End User Point and Click Amendment:</b><br><br> CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the
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for California and New York, please review the geographic information for that document and confirm that the document is relevant for your location of service. </p>
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PUBLIC COMMENTS
Please Note: There are currently no National Coverage Documents open for public
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AMA CPT / ADA CDT
CPT CODES, DESCRIPTIONS AND OTHER DATA ONLY ARE COPYRIGHT 2022 AMERICAN MEDICAL
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ARTICLE INFO
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Local coverage Articles are a type of educational document published by the
Medicare Administrative Contractors (MACs). Articles often contain coding or
other guidelines that complement a Local Coverage Determination (LCD).
MACs are Medicare contractors that develop LCDs and Articles along with
processing of Medicare claims.
There are different article types:
Billing and Coding articles provide guidance for the related Local Coverage
Determination (LCD) and assist providers in submitting correct claims for
payment. Billing and Coding articles typically include CPT/HCPCS procedure
codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS
Modifier codes. The code lists in the article help explain which services
(procedures) the related LCD applies to, the diagnosis codes for which the
service is covered, or for which the service is not considered reasonable and
necessary and therefore not covered.
Response to Comment (RTC) articles list issues raised by external stakeholders
during the Proposed LCD comment period.
Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes
that are excluded from coverage under this category. The Medicare program
provides limited benefits for outpatient prescription drugs. The program covers
drugs that are furnished "incident-to" a physician's service provided that the
drugs are not "usually self-administered" by the patient. CMS has defined "not
usually self-administered" according to how the Medicare population as a whole
uses the drug, not how an individual patient or physician may choose to use a
particular drug. For purpose of this exclusion, "the term 'usually' means more
than 50 percent of the time for all Medicare beneficiaries who use the drug.
Therefore, if a drug is self-administered by more than 50 percent of Medicare
beneficiaries, the drug is excluded from coverage" and the MAC will make no
payment for the drug.
Draft articles are articles written in support of a Proposed LCD. A Draft
article will eventually be replaced by a Billing and Coding article once the
Proposed LCD is released to a final LCD. Articles are often related to an LCD,
and the relationship can be seen in the "Associated Documents" section of the
Article or the LCD. Article document IDs begin with the letter "A" (e.g.,
A12345). Draft articles have document IDs that begin with "DA" (e.g., DA12345).
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LCD INFO
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A Local Coverage Determination (LCD) is a decision made by a Medicare
Administrative Contractor (MAC) on whether a particular service or item is
reasonable and necessary, and therefore covered by Medicare within the specific
jurisdiction that the MAC oversees.
MACs are Medicare contractors that develop LCDs and process Medicare claims.
MACs develop an LCD when there is no national coverage determination (NCD)
(e.g., when an item or service is new) or when there is a need to further define
an NCD for the specific region.
LCDs are specific to an item or service (procedure) and they define the specific
diagnosis (illness or injury) for which the item or service is covered. LCDs
outline how the contractor will review claims to ensure that the services
provided meet Medicare coverage requirements.
Before an LCD becomes final, the MAC publishes Proposed LCDs, which include a
public comment period.
LCD document IDs begin with the letter "L" (e.g., L12345). Proposed LCD document
IDs begin with the letters "DL" (e.g., DL12345).
The guidelines for LCD development are provided in Chapter 13 of the Medicare
Program Integrity Manual. The Social Security Act, Sections 1869(f)(2)(B) and
1862(l)(5)(D) define LCDs and provide information on the process.
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NCD INFO
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NCDs are national policy granting, limiting or excluding Medicare coverage for a
specific medical item or service. These are developed and published by CMS and
apply to all states. NCDs are made through an evidence-based process, with
opportunities for public participation.
Medicare coverage is limited to items and services that are considered
"reasonable and necessary" for the diagnosis or treatment of an illness or
injury (and within the scope of a Medicare benefit category). An NCD sets forth
the extent to which Medicare will cover specific services, procedures, or
technologies on a national basis. Medicare Administrative Contractors (MACs) are
required to follow NCDs
If an NCD does not specifically exclude/limit an indication or circumstance, or
if the item or service is not mentioned at all in an NCD or in a Medicare
manual, an item or service may be covered at the discretion of the MAC based on
a Local Coverage Determination (LCD). LCDs cannot contradict NCDs, but exist to
clarify an NCD or address common coverage issues.
Prior to implementation of an NCD, CMS must first issue a Manual Transmittal,
CMS ruling, or Federal Register Notice giving specific directions to
claims-processing contractors. That issuance, which includes an effective date
and implementation date, is the NCD. If appropriate, the Agency must also change
billing and claims processing systems and issue related instructions to allow
for payment. The NCD will be published in the Medicare National Coverage
Determinations Manual. An NCD becomes effective as of the date of the decision
memorandum.
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NCA/CAL INFO
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NCAs: National Coverage Analysis (NCA). When an NCD is under consideration,
either a new review or a reconsideration, there are numerous documents that
support the process. These documents are considered the NCA. They include
tracking sheets to inform the public of the issues under consideration and the
status (i.e., Pending, Closed) of the review, information about and results of
MEDCAC (formerly known as MCAC) meetings, Technology Assessments, and Decision
Memoranda that announce CMS's intention to issue an NCD. These documents, along
with the compilation of medical and scientific information currently available,
any FDA safety and efficacy data, clinical trial information, etc., provide the
rationale behind the evidence-based NCDs.
CALs: Coding Analyses for Labs (CAL) is an abbreviated process, similar to the
National Coverage Determination (NCD) process, for making changes to the coding
component of the negotiated laboratory NCDs. The process is used for adjusting
the list of covered (or non-covered) ICD-10-CM diagnosis codes and coding
guidance in the NCDs when there is a question regarding whether the code flows
from the narrative indications in the NCD. A tracking sheet is posted opening a
CAL and a 30-day public comment period follows. A decision memorandum announcing
and explaining the decision is posted following the comment period. Changes are
implemented in the next available quarterly update of the laboratory edit
module. More details regarding the process can be found in 68 FR 74607.
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MEDCAC INFO
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The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) process
was established to provide independent guidance and expert advice to CMS on
specific clinical topics. It is used to supplement CMS's internal expertise and
to ensure an unbiased and contemporary consideration of "state of the art"
technology and science.
The MEDCAC reviews and evaluates medical literature, reviews technology
assessments, public testimony and examines data and information on the benefits,
harms, and appropriateness of medical items and services that are covered under
Medicare or that may be eligible for coverage under Medicare. The MEDCAC judges
the strength of the available evidence and makes recommendations to CMS based on
that evidence. They advise CMS on whether specific medical items and services
are reasonable and necessary under Medicare law. They perform this task in an
open and public forum. The MEDCAC is advisory in nature, with the final decision
on all issues resting with CMS. MEDCAC members are valued for their background,
education, and expertise in a wide variety of scientific, clinical, and other
related fields. In composing the MEDCAC, CMS was diligent in pursuing ethnic,
gender, geographic, and other diverse views, and to carefully screen each member
to determine potential conflicts of interest. You can read more about the
Factors CMS Considers in Referring Topics to the Medicare Evidence Development &
Coverage Advisory Committee.
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TA INFO
×
Each National Coverage Determination (NCD) is supported by a comprehensive
Technology Assessment (TA) process, which often focuses on the quality of the
evidence for a given technology.
Health care Technology Assessment is a multidisciplinary field of policy
analysis that studies the medical, social, ethical and economic implications of
the development, diffusion and use of technologies. For some NCDs, external TAs
are requested through the Agency for Health Research and Quality (AHRQ).
You can read about the Factors CMS Considers in Commissioning External
Technology Assessments, which includes a description of the TA process and
guiding principles for selecting which topics are referred.
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MCD INFO
×
Medicare Coverage Documents are published by CMS to help to relay information
that is related to coverage on a national level. Examples include guidance
documents, compendia, and solicitations of public comments.
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CPT/HCPCS INFO
×
Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding
System (HCPCS) procedure codes comprise the medical code set that identifies
health care procedures, equipment, and supplies for claim submission purposes.
HCPCS Level I, also known as the CPT codes, are 5-character numeric codes
maintained by the American Medical Association (AMA). The CPT codes are used
primarily to identify medical services and procedures furnished by physicians
and other health care professionals.
HCPCS Level II are 5-character alphanumeric codes maintained by CMS (except D
codes, which are maintained by the American Dental Association). They are used
to identify various items and services that are not included in the CPT code set
because they are medical items or services that are regularly billed by
suppliers other than physicians. For example, ambulance services, hearing and
vision services, drugs, and durable medical equipment.
When a provider submits a bill to insurance for reimbursement, each service is
described by a CPT or HCPCS code, which is matched to an ICD-10-CM or ICD-10-PCS
diagnosis code. If the CPT/HCPCS and ICD-10-CM / ICD-10-PCS codes don't align
correctly with each other, payment may be rejected. Local Coverage Articles,
authored by the Medicare Administrative Contractors (MACs), include these codes
and, when paired with the related Local Coverage Determination (LCD), outline
what is and is not covered by Medicare.
On the Medicare Coverage Database (MCD) you can use CPT/HCPCS codes to search
for documents. Results will return Billing and Coding Articles or other
documents that include the specified code. (Note: Sometimes an EOB or MSN may
display the CPT/HCPCS code with an associated modifier, which is represented by
a dash and two characters. Examples: 76942-26 and 98941-GA. Occasionally,
multiple modifiers may be listed together (e.g., A5514-RTKX). When searching the
MCD for a CPT/HCPCS code, the modifier should be removed. (E.g., only 76942 or
98941 would be entered.) When viewing a document (e.g., a Billing and Coding
Article) the user may want to then search within the document (CTRL+F) to look
for the modifier code.
Close
ICD-10-CM INFO
×
International Classification of Diseases, Revision 10, Clinical Modification
(ICD-10-CM) is a medical classification list by the World Health Organization
used by physicians and other healthcare providers to classify and code all
diagnoses recorded in conjunction with medical care in the United States.
ICD-10-CM is the standard transaction code set for diagnostic purposes under the
Health Insurance Portability and Accountability Act (HIPAA). These codes ensure
that a patient gets proper treatment and is charged appropriately for any
medical services received.
ICD-10-CM contains codes for diseases, signs and symptoms, abnormal findings,
complaints, social circumstances, and external causes of injury or diseases. In
the base classification, the code set allows for more than 72,000 different
codes. Through the use of optional sub-classifications ICD-10-CM allows for
specificity regarding the cause, manifestation, location, severity and type of
injury or disease. ICD-10-CM codes have an alphanumeric structure and should be
used to the highest number of digits available or highest specificity up to 7
characters.
The CMS ICD-10 Procedure Coding System (ICD-10-PCS) is a catalog of procedural
codes used by medical professionals for hospital inpatient healthcare settings.
The Centers for Medicare and Medicaid Services in tandem with the National
Center for Health Statistics, maintain the catalog in the U.S. releasing yearly
updates. ICD-10-PCS codes have a structure of 7 alphanumeric characters and
contains no decimals. The first character defines the major "section". Depending
on the "section" the second through seventh characters mean different things.
When a provider submits a bill to insurance for reimbursement, each service is
described by a current procedural terminology (CPT) or healthcare common
procedure code system (HCPCS) code, which is matched to an ICD-10-CM or
ICD-10-PCS code. If the CPT/HCPCS and ICD-10-CM / ICD-10-PCS codes don't align
correctly with each other, payment may be rejected. Local Coverage Articles,
authored by the Medicare Administrative Contractors (MACs), include these codes
and, when paired with the related Local Coverage Determination (LCD), outline
what is and is not covered by Medicare.
On the Medicare Coverage Database (MCD) you can use ICD-10-CM codes to search
for documents. Results will return Billing and Coding Articles or other
documents that include the specified code.
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* might
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* most
* much
* must
* my
* n
* never
* no
* now
* o
* of
* on
* only
* or
* other
* our
* out
* over
* p
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* r
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* s
* said
* same
* see
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* t
* take
* than
* that
* the
* their
* them
* then
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* these
* they
* this
* those
* through
* to
* too
* u
* under
* up
* use
* v
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* w
* want
* was
* way
* we
* well
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LICENSE AGREEMENTS
Please review and accept the agreements in order to view Medicare Coverage
documents, which may include licensed information and codes.
LICENSE FOR USE OF PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION
("CPT")
End User Point and Click Amendment:
CPT codes, descriptions and other data only are copyright 2022 American Medical
Association. All Rights Reserved (or such other date of publication of CPT). CPT
is a trademark of the American Medical Association (AMA).
You, your employees and agents are authorized to use CPT only as agreed upon
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the sole use by yourself, employees and agents. Use is limited to use in
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and Medicaid Services (CMS). You agree to take all necessary steps to insure
that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration
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License to use CPT for any use not authorized herein must be obtained through
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Applicable FARS\DFARS Restrictions Apply to Government Use.
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Should the foregoing terms and conditions be acceptable to you, please indicate
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LICENSE FOR USE OF CURRENT DENTAL TERMINOLOGY (CDTTM)
End User License Agreement:
These materials contain Current Dental Terminology (CDTTM), copyright© 2022
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1. Subject to the terms and conditions contained in this Agreement, you, your
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agreement, creating any modified or derivative work of CDT, or making any
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Association web site, http://www.ADA.org.
3. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of
Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply
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or related to any use, non-use, or interpretation of information contained
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The license granted herein is expressly conditioned upon your acceptance of
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LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)
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PAGE HELP FOR MCD SEARCH
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INTRODUCTION
The MCD Search page is the starting point to search for Medicare Coverage
documents. It allows users to identify and view both National and Local Coverage
documents that reside within the database.
National Coverage documents maintained in the MCD include:
* National Coverage Determinations (NCDs)
* National Coverage Analyses (NCAs)
* Coding Analyses for Labs (CALs)
* Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) meetings
* Technology Assessments (TA)
* Medicare Coverage Documents (MCDs)
Local Coverage documents maintained in the MCD include:
* Articles
* Local Coverage Determinations (LCDs)
Learn more about the various document types found in the MCD
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ENTER SEARCH TERM
Start a search by entering your search term in the search box.
Enter one of the following types of search terms:
* Keyword: For example, "Acupuncture". This type of search will return all
documents containing your search term.
* CPT/HCPCS procedure (billing) code: For example, "92250". CPT/HCPCS codes are
only included in Local Coverage Articles and certain Durable Medical
Equipment (DME) LCDs, or possibly in retired versions of LCDs. This type of
search will return all documents containing the CPT/HCPCS code.
* ICD-10-CM code: For example, "E08.621". ICD-10-CM codes are only included in
Local Coverage Articles, or possibly in retired versions of LCDs. This type
of search will return all documents containing the ICD-10-CM code.
* Document ID: For example, "A12345", "L12345", "CAG-00044N". Please Note that
MEDCAC Meetings, TAs, and MCDs do not have document IDs. Entering a document
ID will directly open the document.
* Contractor name: This will return all documents pertaining to the specified
contractor. Accepted values are: CGS, First Coast, NGS, Noridian, Novitas,
Palmetto, and WPS.
Please note you can perform a search while leaving the search box empty. This
will return all documents in the MCD.
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HINT LIST
As you enter your search term, a hint list will appear below the search box to
help you with your search. If you see what you need in the hint list, you can
select it. Otherwise, launch your search by pressing the <Enter> key or clicking
on the green magnifying glass.
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AMA LICENSE AGREEMENT
If you enter a CPT/HCPCS code, you may see a yellow bar. Click on it to view and
accept the AMA License Agreement. This will allow you to see matching CPT/HCPCS
codes in the hint list.
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SMART SEARCHES
The MCD offers some limited smart search capability. The following are examples
of some smart searches you can enter:
* "LCDs for cancer" will return LCDs that contain the word "cancer".
* "Acupuncture articles" will return Local Coverage Articles that contain the
word "acupuncture".
* "Billing and coding articles for colonoscopy" will return Billing & Coding
Articles that contain the word "colonoscopy".
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NARROWING YOUR SEARCH BY THE STATE
You can narrow your search to only those documents associated with a particular
state by selecting the state where the service took place.
PARTIAL STATE SELECTIONS
Both California and New York support partial state selections. The state
selections for California include "California - Entire State", "California -
Northern" and "California - Southern" and New York include "New York - Entire
State", "New York - Downstate", "New York - Queens", "New York - Upstate".
When searching documents for California and New York, your results may include
documents that are not relevant for your location. For example, if your location
of service was in Southern California, your results may include documents that
are associated only with "California - Northern", which may not be relevant.
When viewing Articles and LCDs for California and New York, please review the
geographic information for that document and confirm that the document is
relevant for your location of service.
CMS REGIONS
Within the state dropdown list, you can also select to narrow your search by CMS
Region. The CMS Regions are broken out by state as follows:
* CMS Region 1: CT, MA, ME, NH, RI, VT
* CMS Region 2: NJ, NY, Puerto Rico (PR), Virgin Islands (VI)
* CMS Region 3: DC, DE, MD, PA, VA, WV
* CMS Region 4: AL, FL, GA, KY, MS, NC, SC, TN
* CMS Region 5: IL, IN, MI, MN, OH, WI
* CMS Region 6: AR, LA, NM, OK, TX
* CMS Region 7: IA, KS, MO, NE
* CMS Region 8: CO, MT, ND, SD, UT, WY
* CMS Region 9: AZ, CA, HI, NV, American Samoa (AS), Guam (GU), Northern
Mariana Islands (CNMI)
* CMS Region 10: AK, ID, OR, WA
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FREQUENTLY ASKED QUESTIONS (FAQS)
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Many questions can be answered on the Help & Resources page in the How To
Library or by viewing the FAQs below. Please take a look and if you still have
questions or would like to leave feedback, contact us!
ARE YOU A PROVIDER AND HAVE A QUESTION ABOUT BILLING OR CODING?
Please contact your Medicare Administrative Contractor (MAC). MACs can be found
in the MAC Contacts Report.
DO YOU HAVE QUESTIONS RELATED TO THE CONTENT OF A SPECIFIC LOCAL COVERAGE
DETERMINATION (LCD) OR AN ARTICLE?
Please contact the Medicare Administrative Contractor (MAC) who owns the
document. The contractor information can be found at the top of the document in
the Contractor Information section (expand the section to see the details). MACs
can also be can be found in the MAC Contacts Report.
ARE YOU A BENEFICIARY AND HAVE QUESTIONS ABOUT YOUR COVERAGE?
Please call 1-800-Medicare or visit Medicare.gov Opens in a new window
ARE YOU LOOKING FOR CODES? (E.G., CPT/HCPCS, ICD-10)
LOCAL COVERAGE
For the most part, codes are no longer included in the LCD (policy). You will
find them in the Billing & Coding Articles. Try using the MCD Search to find
what you're looking for. Enter the code you're looking for in the "Enter
keyword, code, or document ID" box. The list of results will include documents
which contain the code you entered.
Please Note: For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes
remain located in LCDs. All other Codes (ICD-10, Bill Type, and Revenue) have
moved to Articles for DME MACs, as they have for the other Local Coverage MAC
types.
NATIONAL COVERAGE
NCDs do not contain claims processing information like diagnosis or procedure
codes nor do they give instructions to the provider on how to bill Medicare for
the service or item. For this supplementary claims processing information we
rely on other CMS publications, namely Change Requests (CR) Transmittals and
inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM).
In order for CMS to change billing and claims processing systems to accommodate
the coverage conditions within the NCD, we instruct contractors and system
maintainers to modify the claims processing systems at the national or local
level through CR Transmittals. CRs are not policy, rather CRs are used to relay
instructions regarding the edits of the various claims processing systems in
very descriptive, technical language usually employing the codes or code
combinations likely to be encountered with claims subject to the policy in
question. As clinical or administrative codes change or system or policy
requirements dictate, CR instructions are updated to ensure the systems are
applying the most appropriate claims processing instructions applicable to the
policy.
HOW DO I FIND OUT IF A SPECIFIC CPT CODE IS COVERED IN MY STATE?
Enter the CPT/HCPCS code in the MCD Search and select your state from the drop
down. (You may have to accept the AMA License Agreement.) Look for a Billing and
Coding Article in the results and open it. (Or, for DME MACs only, look for an
LCD.) Review the article, in particular the Coding Information section.
If you need more information on coverage, contact the Medicare Administrative
Contractor (MAC) who published the document. The contractor information can be
found at the top of the document in the Contractor Information section (expand
the section to see the details).
If you don’t find the Article you are looking for, contact your MAC.
DID YOU RECEIVE A MEDICARE COVERAGE DENIAL?
Was your Medicare claim denied? Here are some hints to help you find more
information:
1) Check out the Beneficiary card on the MCD Search page.
2) Try using the MCD Search and enter your information in the "Enter keyword,
code, or document ID" box. Your information could include a keyword or topic
you're interested in; a Local Coverage Determination (LCD) policy or Article ID;
or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code. Try
entering any of this type of information provided in your denial letter.
3) Contact your MAC.
4) Visit Medicare.gov Opens in a new windowor call 1-800-Medicare.
IT IS THURSDAY AND THE WEEKLY MCD DATA ISN’T REFRESHED?
Please use the Reset Search Data function, found in the top menu under the
Settings (gear) icon. If that doesn’t work please contact technical support.
ARE YOU HAVING TECHNICAL ISSUES WITH THE MEDICARE COVERAGE DATABASE (MCD)?
Technical issues include things such as a link is broken, a report fails to run,
a page is not displaying correctly, a search is taking an unexpectedly long time
to complete. If you are having an issue like this please contact technical
support.
Submit Feedback/Ask a Question Cancel
MCD SESSION EXPIRATION WARNING
Your MCD session is currently set to expire in 5 minutes due to inactivity. If
your session expires, you will lose all items in your basket and any active
searches. If you would like to extend your session, you may select the Continue
Button.
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RESET MCD SEARCH DATA
If you are experiencing any technical issues related to the search, selecting
the 'OK' button to reset the search data should resolve your issues.
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contains outdated (No Longer In Effect) Local Coverage Determinations and
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