Local Coverage Determinations Create Inconsistency in Coverage

“Medicare administrative contractors (MACs) and the Centers for Medicare & Medicaid Services (CMS) sometimes develop policies to limit Medicare coverage of specific items and services. MACs issue local coverage determinations (LCDs) that limit coverage for a particular item or service in their jurisdictions only. This can lead to State-by-State variation in Medicare coverage for similar items and services. …In October 2011, over half of Part B procedure codes were subject to an LCD in one or more States.” 

Source: https://oig.hhs.gov/oei/reports/oei-01-11-00500.pdf

Daniel R. Levinson Inspector General, Department of Health and Human Services. Local Coverage Determinations Create Inconsistency in Medicare Coverage. January 2014, OEI-01-11-00500

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