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Did You Know? – Local Coverage Determinations (LCD)

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  1. Where can I find the CGS LCDs?
  2. How do I request a Local Coverage Determination (LCD) be developed?
  3. A Local Coverage Determination (LCD) is denoted as Superceded on the CMS web-site. Where can I find the advisory, notice or policy that gives the verbiage which super-cedes?

    • When an LCD is revised, this is noted at the end of the LCD by the stamp 'Superceded'.

      Reviewed 09/22/2021
  4. Why is my claim denying based on a policy when I am using a diagnosis in the billing and coding policy article?

    • We have seen an increase of denials for this situation and after reviewing data the reason for the denial is one of the following.

      • Use of a diagnosis that is in the billing and coding policy article but not related to the service performed.
        • In some billing and coding articles there are ICD-10 groups that are specific for certain CPT codes but not related to all CPT codes in the article. The ICD-10 group paragraph will have the CPT code that group of diagnoses supports medical necessity.
      • Use of only one ICD-10 code when there is a dual diagnosis requirement.
        • If a billing and coding article has a dual diagnosis requirement, this will be indicated in the ICD-10 group paragraph with an indication of primary diagnosis and the group below with secondary diagnosis.
      • Use of an unspecified diagnosis.
        • In many cases, CGS does not include the unspecified ICD-10 code in a series because the other codes are more specific. There are times an unspecified code may be included so we ask that you review the billing and coding article to verify the unspecified code is listed as one that supports medical necessity.
      Reviewed 09/22/2021

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