I want to get paid for my work. I deliver great customer service and high quality noninvasive vascular testing. Don't get me wrong….I can be charitable too. But, I have expenses to cover. The same is true for my employer. Because we want to get paid, it is important to monitor for changes in reimbursement. In this post, I will look at Local Coverage Determinations, or LCDs.
An LCD is a determination by a Medicare Administrative Contractor (MAC) that defines coverage for a particular service in the contractor's jurisdiction. LCDs must be consistent with all statutes, rulings, regulations, and national policies for coverage, payment, and coding. LCDs may address a specific clinical topic using CPT/HCPCS codes to define one or more treatments and using ICD-10 codes to describe the clinical indications that would make the treatment(s) reasonable and necessary. How does this apply to me? An LCD may limit coverage of a noninvasive vascular exam to specific diagnoses, or it may prohibit coverage in certain situations. So, even though I provide great service and quality exams, my employer may not get paid. If this happens repeatedly, I am likely to be without a job and my patients will have to find another provider.
LCDs are publicly available in the Medicare Coverage Database (MCD) on the CMS website, which is updated weekly. The MCD also contains all National Coverage Determinations (NCDs), local articles, and proposed NCD decisions.
While the MCD has a lot of features, I find it easier to search for my LCD by state. Remember, MACs issue LCDs. MACs are multi-state, regional contractors responsible for administering Medicare Part A/B. Currently, there are 12 such MACs. If you are talking with colleagues in different areas of the country, their work may be covered by different LCDs.
I work in Kentucky, so my search brought up these results.
From there, I selected LCD L34045: Non-Invasive Vascular Studies.
Check out LCDs for your state….it is important if you want to get paid! Did you find something that surprised you? If so, let me know.