Medicare Carriers Links to Local Coverage Determinations & Articles
The Public Policy team has developed a state-by-state listing of Local Coverage Determinations (LCD’s) and Policy Articles. LCDs and Policy Articles contain critical information regarding coverage issues that may affect your ability to be reimbursed. The information includes indications and limitations of coverage and/or medical necessity, ICD-10 Codes that support medical necessity, documentation requirements, and utilization or frequency guidelines.
LCDs are formal decisions by the carrier or fiscal intermediary regarding whether to cover a particular service or whether a service is reasonable and necessary for certain diagnoses. Before issuing an LCD, the carrier must provide a notice and comment period to allow comment on the proposed document. A Policy Article is a less formal document used by the carrier or fiscal intermediary to communicate information to providers. The carrier is not required to give notice or provide an opportunity for providers to comment on Articles before being issued. Articles may articulate new coding instructions or clarify existing claims or billing policies. (Medicare Program Integrity Manual, Chapter 13-Local Coverage Determinations Rev. 253, 4-25-08).
The amount of guidance provided by carriers through LCDs and Articles varies widely from state to state. For example, while some carriers have issued several documents relevant to bone density testing, others have issued nothing. LCD and Article topics include Coding for Bone Mass Measurement, Vertebral Fracture Assessment, Bisphosphonate Drug Therapy, Use of Intravenous Bisphosphonates, and Vitamin D Assay Testing.
Where we have identified relevant LCD’s or Articles, that information is listed in a searchable format by state. The links included in the listing will allow you to download and save the relevant LCDs and/or articles for your Medicare carrier. In the absence of an Article or an LCD for bone mass measurement or testing, please click here to link to the National Coverage Determination on Bone Mineral Density Studies. (Updates are included through links within the document.) If VFA is not referenced in either an LCD or Article, please refer to the National Coverage Determination. This information has been updated as of February 2016. If you have any questions about these resources, contact Donna Fiorentino (email@example.com).