What is a Medicare LCD? Why is it Important?
The American Occupational Therapy Association (AOTA) Regulatory Affairs department works diligently to protect Medicare coverage and payment for occupational therapy (OT) services in all settings. Under the Medicare Program, Medicare contracts with regional corporate entities that process and pay claims for services provided in their regions. These entities are called Medicare Administrative Contractors (MACs) and also have the authority to develop medical coverage policies, usually based on discipline (e.g., occupational therapy; physical therapy) or by type of service (e.g., dysphagia services; wound care services).
The medical coverage policies that MACs develop are referred to as Local Coverage Determinations (LCDs), which are coverage and payment policies used at the regional level throughout the country to interpret national Medicare policy issued by the responsible federal agency, Centers for Medicare and Medicaid Services (CMS). LCDs undergo periodic review and revision by local Medicare contractors. During these periods of review, LCDs are open for public comment and challenge.
This page provides you with detailed guidance about LCDs, including how to identify your contractor’s occupational therapy LCD, appeal Medicare coverage denials and change inaccurate LCDs.
Review a Contractor Directory, an interactive map.
Find E-mail contacts, so you may contact your MAC directly with ICD-10 inquiries.
Get To Know Your Medicare Administrative Contractor (MAC).
Take Proactive Steps To Better Payment.
How AOTA Advocates For You.
Use a Sample LCD Appeal Letter as a Template.