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LCDs / Medical Policies

A Local Coverage Determination (LCD), as defined in §1869(f)(2)(B) of the Social Security Act (SSA), is a Medicare Administrative Contractor's (MAC's) determination as to whether a particular item or service is covered on a contractor-wide basis in accordance with §1862(a)(1)(A) of the Act.

Reference the CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 13External PDF for details about the LCD process.

How to Find CGS J15 LCDs & Articles

NOTE: CMS and MACs don't develop an NCD and/or LCD for each item or service that Medicare covers. In the absence of a national/local coverage policy, reference the Social Security Act, CMS Medicare Benefit Policy Manual (Pub. 100-02)External website, Code of Federal Regulations, and/or other CMS/CGS resources for coverage guidance.

  1. Search the Medicare Coverage Database (MCD)External website (includes all national/local coverage policy related document types) or the MCD ArchiveExternal website (contains outdated (no longer in effect) LCDs and articles). See the How to Use the Medicare Coverage DatabaseExternal website MLN educational tool for details.
  2. Use the direct links to CGS J15 active and future LCDs and articles provided in the table below.
ID Title Effective Date Revision Effective Date Last Updated Status HCPCS/CPT Code Article(s)
L34538External Website Hospice Determining Terminal Status 10/1/2015 6/27/24 7/11/24 Active N/A N/A
L33942External Website Physical Therapy – Home Health 10/1/2015 6/27/24 7/11/24 Active Group 1:
G0151

Group 2:
95851, 95852, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97110, 97112, 97113, 97116, 97124, 97140, 97161, 97162, 97163, 97164, 97530, 97535, 97542, 97750, 97755, 97760, 97761, 97763, G0281, G0283, G0329

Group 3:
98966, 98967, 98968, 98970, 98971, 98972, 98975, 98976, 98977, 98980, 98981, G2010, G2012, G2250, G2251
A57311 – Billing and Coding: Physical Therapy – Home HealthExternal Website
N/A Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage – Medical Policy Article 10/1/15 6/30/24 5/9/24 Active See the Coding Information section in the article A52527 – Self-Administered Drug Exclusion List: and Biologicals Excluded from Coverage – Medical Policy ArticleExternal Website

Updated: 07.29.24

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