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Before sharing sensitive information, make sure you're on a federal government site.The site is secure.Thehttps://ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.Resource NavigationSearchReportsDownloadsArchiveAPIopens in new window<button id="toggle-mobile-search" class="mobile-search-btn" aria-expanded="false"><span class="ds-u-visibility--screen-reader">Toggle Mobile Search</span></button>Close SearchCenters for Medicare & Medicaid ServicesMain headerAbout UsNewsroomData & ResearchMCDMedicare Coverage DatabaseSearchReportsNational CoverageWhat's New ReportAnnual ReportNCA/CAL ReportsNCA/CAL Status ReportNCA/CAL Open for Public Comment ReportNCD ReportMedicare Coverage Documents ReportsMedicare Coverage Documents ReportMed Cov Docs Open for Public Comment ReportOther National Coverage ReportsMEDCAC Meetings ReportTechnology Assessments ReportLocal CoverageWhat's New ReportFinal LCD ReportsFinal LCDs by Contractor ReportFinal LCDs by State ReportFinal LCDs Alphabetical ReportProposed LCD ReportsProposed LCDs by Contractor ReportProposed LCDs by State ReportProposed LCDs Alphabetical ReportArticle ReportsArticles by Contractor ReportArticles by State ReportArticles Alphabetical ReportSAD Exclusion List ReportMAC Contacts ReportDownloadsHelp & ResourcesPage HelpTour the SearchTour the ReportsContact UsReset Search DataArchiveAPIWelcome to theMCDSearchThe document version that you are looking for is now on the MCD Archive. Please visit theMCD Archiveto view the Document.View the full list of generic words.Start your search...Keyword, Document ID, or Code searchSelect a State/RegionAll StatesAlabamaAlaskaAmerican SamoaArizonaArkansasCalifornia - Entire StateCalifornia - NorthernCalifornia - SouthernColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew York - DownstateNew York - Entire StateNew York - QueensNew York - UpstateNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingCMS Region 1CMS Region 2CMS Region 3CMS Region 4CMS Region 5CMS Region 6CMS Region 7CMS Region 8CMS Region 9CMS Region 10colrowNotice Board12/14/2023Check out the Latest Site Updates08/01/2023Notice:Coverage API06/03/2022How To Use The Medicare Coverage DatabaseBeneficiary?Are you a beneficiary and need help using the MCD?Need more help? Visitmedicare.govfor beneficiary-specific information or call 1-800-MEDICARE for other questions.Looking for health care providers and services?Find a health care provider on medicare.govPublic CommentsSee National Coverage Analyses (NCAs) Open for Public CommentSee Coding Analysis for Labs (CALs) Open for Public CommentSee Medicare Coverage Documents Open for Public CommentPlease Note:There are currently no National Coverage Documents open for public comment.AMA CPT / ADA CDTCPT codes, descriptions and other data only are copyright2023American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.Current Dental Terminology 2023American Dental Association. All rights reserved.colrowNoticeYou are leaving the CMS MCD and are being redirected to Medicare.govContinueCancelNoticeYou are leaving the CMS MCD and are being redirected to Medicare.govContinueCancelArticle InfoArticles are a type of document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines and may or may not be in support of a Local Coverage Determination (LCD).Articles which directly support an LCD are known as LCD Reference Articles. The referenced LCD may be cited in the Article Text field and may also be linked to in the Related Documents field. Examples may include but are not limited to Response to Comments and some Billing and Coding Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article.Articles identified as Not an LCD Reference Article are articles that do not directly support a Local Coverage Determination (LCD). They do not include a citation of an LCD. An example would include, but is not limited to, the Self-Administered Drug (SAD) Exclusion List Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section ofthe article.There are different article types:Billing and Coding articlesprovide guidance for the related Local Coverage Determination (LCD) and assist providers in submittingcorrect claims for payment. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, aswell as Bill Type, Revenue, and CPT/HCPCS Modifier codes. The code lists in the article help explain which services (procedures) therelated LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable andnecessary and therefore not covered.Response to Comment (RTC) articleslist issues raised by external stakeholders during the Proposed LCD comment period.Self-Administered Drug (SAD) Exclusion List articleslist 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 "notusually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient orphysician may choose to use a particular drug. For purpose of this exclusion, "the term 'usually' means more than 50 percent of thetime for all Medicare beneficiaries who use the drug. Therefore, if a drug is self-administered by more than 50 percent of Medicarebeneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug.Draft articlesare articles written in support of a Proposed LCD. A Draft article will eventually be replaced by a Billing and Coding articleonce 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).CloseLCD InfoA Local Coverage Determination (LCD) is a decision made by a Medicare Administrative Contractor (MAC) on whether a particular serviceor 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) or when there is a need to further define an NCD for the specific jurisdiction.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.CloseNCD InfoNCDs 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 NCDsIf 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.CloseNCA/CAL InfoNCAs: 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.CloseMEDCAC InfoThe 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.