Local Coverage Determinations (LCDs)

While the Medicare statute and regulations specify types of items and services that are considered medically necessary and NCDs determine more specific national coverage criteria for certain services and items, local Medicare carriers and intermediaries may develop Local Coverage Determinations (LCDs) to inform their providers about which items or services of that type they will cover.

An LCD is a formal determination by a Medicare contractor (i.e., fiscal intermediary or carrier) whether a particular item or service is reasonable and necessary and should be covered in the contractor’s jurisdictions. Contractors were required to develop LCDs in a final rule that was effective as of December 8, 2003. The objective of an LCD is to assist providers in submitting correct claims for payment to ensure that they meet Medicare coverage and coding requirements.

This section contains information to help you identify your contractor’s occupational therapy LCD, provide resources and tools to fight Medicare denials, and provide examples of LCD comment letters for specific services or items.