Difference between LCDs and LMRPs

LCDs (Local coverage determinations) are defined in Section 1869(f)(2)(B) of the Social Security Act

. For the purpose of this section, the term local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or for that matter part B, as valid, respecting whether or not a particular item or service is covered on an intermediary or carrier-wide basis under such parts.

Difference between LCDs and LMRPs

The difference between LCDs and LMRPs contain only reasonable and necessary conditions of coverage as permitted under section 1862(a)(1)(A) of the Act. The previously written LMRPs may also cover other information like coding and payment guidelines.

LCDs are in actuality limited to coverage questions relative to medical necessity, and not to other coverage issues or to coding issues. But there are other elements that are included to make it easier for providers and contractors to reference the LCD and apply it smoothly. For instance this includes lists of HCPCS and CPT codes that make clear which services the LCD applies to and lists of ICD-9 codes for which the service is covered. Few of the LMRPs may contain benefit category, statutory exclusions, and coding provisions.

For more information on LCDs, sign up for a one-stop Medical Coding website. When you sign up for one, you'll have access to the LCD tool that quickly delivers the ICD-9-CM codes that your contractor type permits for a given CPT code . You simply need to enter your CPT code, choose your contractor type and your state.

Difference between LCDs and LMRPs

By: James Smith

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