LCD Local Coverage Determination
A coverage decision by a Medicare Administrative Contractor that defines when a service is reasonable and necessary within that contractor's jurisdiction.
A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor (MAC) about whether a particular item or service is covered — that is, reasonable and necessary — in the MAC's jurisdiction.
How LCDs fit with other coverage rules
- A National Coverage Determination (NCD) from CMS applies nationwide and takes precedence.
- When there is no NCD, or when an NCD leaves details to contractors, a MAC may issue an LCD.
- LCDs are usually accompanied by a billing and coding article that lists relevant CPT/HCPCS codes, ICD-10-CM codes that support medical necessity, and billing instructions.
Why LCDs matter to coders and billers
LCDs explain the clinical criteria and documentation needed for coverage. Because they are local, a service may have different requirements in different states. Coding a diagnosis just because it appears in an LCD's covered list — without documentation support — is a compliance risk.
Where to find them
All NCDs, LCDs and billing and coding articles are searchable in the Medicare Coverage Database. LCDs go through a public proposal and comment process before becoming final.