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Local Coverage Determinations

Guidance for general public on background of Local Coverage Determinations.

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: January 30, 2020

What is an LCD?

Local coverage determinations (LCDS) are defined in Section 1869(f)(2)(B) of the Social Security Act (the Act). This section states: “For purposes of this section, the term ‘local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary- or carrier-wide basis under such parts, in accordance with section 1862(a)(1)(A).”

Upcoming meetings
DateMAC/JurisdictionLocationIssues/Topics
June 15, 2022 (PDF)
1:00 PM CT – 3:00 PM CT
WPS/ J8A, J5A, J8B, J5BWebinarDL39356 – MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia and Neoplasia
DL34641 - Transcranial Magnetic Stimulation (TMS)
DL36793 - MolDX: Genetic Testing for Lynch Syndrome
DL36813 - MolDX: BRCA1 and BRCA2 Genetic Testing
DL37005 - MolDX: ConfirmMDx Epigenetic Molecular Assay
DL37013 - 4Kscore® Assay
DL37224 - MolDX: APC and MUTYH Gene Testing
DL37770 - MolDX: CORUS® CAD Assay
June 16, 2022 (PDF)
6:00 PM – 8:00 PM ET
WPS/ J8A, J5A, J8B, J5BWebinarDL39356 – MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia and Neoplasia
DL34641 - Transcranial Magnetic Stimulation (TMS)
DL36793 - MolDX: Genetic Testing for Lynch Syndrome
DL36813 - MolDX: BRCA1 and BRCA2 Genetic Testing
DL37005 - MolDX: ConfirmMDx Epigenetic Molecular Assay
DL37013 - 4Kscore® Assay
DL37224 - MolDX: APC and MUTYH Gene Testing
DL37770 - MolDX: CORUS® CAD Assay
June 21, 2022 (PDF)
4:00-5:00PM ET
CGS/J15In-Person and Teleconference/WebinarKentucky & Ohio Joint In-Person/Onsite Open Public Draft/Revised LCD Discussion Meeting
June 29, 2022 (PDF)
12:00‒3:00 p.m. CT
NGS/J6, JKVirtual
  • Biomarker Testing for Prostate Cancer Diagnosis
  • Drugs and Biologicals
  • Off-label Use of Rituximab and Rituximab Biosimilars
  • Off-label Use of IVIG

Click the date for more information on each meeting

Medicare Administrative Contractors

A / C / D / F / G / H / I / K / L / M / N / O / P / R / S / T / U / V / W

StateJurisdiction (J)Medicare Administrative Contractor (MAC)
Alabama

DME MAC - JC

A/B MAC - JJ

HH + H MAC - JM

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

Alaska

DME MAC - JD

A/B MAC - JF

HH+ H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

American Samoa

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Arizona

DME MAC - JD

A/B MAC - JF

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Arkansas

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

California

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Colorado

DME MAC - JC

A/B MAC - JH

HH + H MAC - J15

CGS Administrators, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

Connecticut

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

Delaware

DME MAC - JA

A/B MAC - JL

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

District of Columbia

DME MAC - JA

A/B MAC - JL

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

Florida

DME MAC - JC

A/B MAC - JN

HH + H MAC - JM

CGS Administrators, LLC

First Coast Service Options, Inc.

Palmetto GBA, LLC

Georgia

DME MAC - JC

A/B MAC - JJ

HH + H MAC - JM

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

Guam

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Hawaii

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Idaho

DME MAC - JD

A/B MAC - JF

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Illinois

DME MAC - JB

A/B MAC - J6

HH + H MAC - JM

CGS Administrators, LLC

National Government Services, Inc.

Palmetto GBA, LLC

Indiana

DME MAC - JB

A/B MAC - J8

HH + H MAC - JM

CGS Administrators, LLC

Wisconsin Physicians Service Government Health Administrators

Palmetto GBA, LLC

Iowa

DME MAC - JD

A/B MAC - J5

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Wisconsin Physicians Service Government Health Administrators

CGS Administrators, LLC

Kansas

DME MAC - JD

A/B MAC - J5

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Wisconsin Physicians Service Government Health Administrators

CGS Administrators, LLC

Kentucky

DME MAC - JB

A/B MAC - J15

HH + H MAC - JM

CGS Administrators, LLC

CGS Administrators, LLC

Palmetto GBA, LLC

Louisiana

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

Maine

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

Maryland

DME MAC - JA

A/B MAC - JL

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

Massachusetts

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

Michigan

DME MAC - JB

A/B MAC - J8

HH + H MAC - J6

CGS Administrators, LLC

Wisconsin Physicians Service Government Health Administrators

National Government Services, Inc.

Minnesota

DME MAC - JB

A/B MAC - J6

HH + H MAC - J6

CGS Administrators, LLC

National Government Services, Inc.

National Government Services, Inc.

Mississippi

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

Missouri

DME MAC - JD

A/B MAC - J5

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Wisconsin Physicians Service Government Health Administrators

CGS Administrators, LLC

Montana

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

Nebraska

DME MAC - JD

A/B MAC - J5

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Wisconsin Physicians Service Government Health Administrators

CGS Administrators, LLC

Nevada

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

New Hampshire

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

New Jersey

DME MAC - JA

A/B MAC - JL

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

National Government Services, Inc.

New Mexico

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

New York

DME MAC - JA

A/B MAC - JK

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

North Carolina

DME MAC - JC

A/B MAC - JM

HH + H MAC - JM

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

North Dakota

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

Northern Mariana Islands

DME MAC - JD

A/B MAC - JE

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Ohio

DME MAC - JB

A/B MAC - J15

HH + H MAC - JM

CGS Administrators, LLC

CGS Administrators, LLC

Palmetto GBA, LLC

Oklahoma

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

Oregon

DME MAC - JD

A/B MAC - JF

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

Pennsylvania

DME MAC - JA

A/B MAC - JL

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Novitas Solutions, Inc.

CGS Administrators, LLC

Puerto Rico

DME MAC - JC

A/B MAC - JN

HH + H MAC - J6

CGS Administrators, LLC

First Coast Service Options, Inc.

National Government Services, Inc.

Rhode Island

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

South Carolina

DME MAC - JC

A/B MAC - JM

HH + H MAC - J M

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

South Dakota

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

Tennessee

DME MAC - JC

A/B MAC - JJ

HH + H MAC - JM

CGS Administrators, LLC

Palmetto GBA, LLC

Palmetto GBA, LLC

Texas

DME MAC - JC

A/B MAC - JH

HH + H MAC - JM

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

Utah

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

Vermont

DME MAC - JA

A/B MAC - JK

HH + H MAC - JK

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

National Government Services, Inc.

Virgin Islands

DME MAC - JC

A/B MAC - JN

HH + H MAC - J6

CGS Administrators, LLC

First Coast Service Options, Inc.

National Government Services, Inc.

Virginia

DME MAC - JC

A/B MAC - JL
(includes Part B for counties of Arlington and Fairfax, and the city of Alexandria)
A/B MAC - JM
(excludes Part B for the counties of Arlington and Fairfax, and the city of Alexandria)

HH + H MAC - J15

CGS Administrators, LLC

Novitas Solutions, Inc.

Palmetto GBA, LLC

CGS Administrators, LLC

Washington

DME MAC - JD

A/B MAC - JF

HH + H MAC - J6

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

National Government Services, Inc.

West Virginia

DME MAC - JC

A/B MAC - JM

HH + H MAC - J15

CGS Administrators, LLC

Palmetto GBA, LLC

CGS Administrators, LLC

Wisconsin

DME MAC - JB

A/B MAC - J6

HH + H MAC - J6

CGS Administrators, LLC

National Government Services, Inc.

National Government Services, Inc.

Wyoming

DME MAC - JD

A/B MAC - JF

HH + H MAC - J15

Noridian Healthcare Solutions, LLC

Noridian Healthcare Solutions, LLC

CGS Administrators, LLC

DME = Durable Medical Equipment
HH+H = Home Health and Hospice
A/B MAC = part A and part B Medicare Administrative Contractors

 

 

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.