Medicare Coverage for Common Endocrine Services

National and Local Coverage Determinations - What You Need to Know

 

What are NCDs and LCDs?

NCDs (National Coverage Determinations) and LCDs (Local Coverage Determinations) are decisions by Medicare and their administrative contractors that provide coverage information and determine whether services are reasonable and necessary on certain services offered by participating providers. They are administrative and educational tools to assist providers in submitting correct claims for reimbursement.

 

What is the difference between an NCD and an LCD?

An NCD is mandated at the national level and all fiscal intermediaries, carriers, and Medicare Administrative Contractors (MACs) follow those guidelines. An LCD is mandated at the MAC level and those guidelines are only applicable to that MAC’s jurisdiction. Medicare contractors develop LCDs when there is no NCD or when there is a need to further define an NCD. The LCD development guidelines are found in Chapter 13 of the Medicare Program Integrity Manual.

 

What is part of an NCD/LCD?

Typically, an NCD/LCD will include codes that describe what is and isn't covered. This includes, for example, lists of HCPCs codes that spell out which services the NCD/LCD applies to, lists of ICD-10-CM codes for which the service is covered, lists of ICD-10 codes for which the service is not considered reasonable and necessary.

 

What do NCD/LCDs specify?

The NCD/LCDs specify under what clinical circumstances a service is considered to be reasonable and necessary.

 

Who publishes and develops NCD/LCDs?

Contractors publish NCDs/LCDs to guide the public and medical community within their jurisdictions. Contractors develop NCDs/LCDs by considering medical literature, the advice of local medical societies and medical consultants, public comments, and provider community comments.

 

Can an NCD/LCD be reconsidered?

Yes. The NCD reconsideration process can be found here and each MAC will have the reconsideration process on its website. A list of all MAC websites is here.

 

What are NCDs on common endocrine services?

Please note the following is not all-inclusive and is subject to change:

Access a list of ALL NCDs.

 

What are LCDs on common endocrine services?

Please note the following is not all-inclusive and is subject to change:

  • Assays for vitamins and metabolic functions
  • Autonomic Function
  • CGM
  • Diagnostic Ultrasounds
  • DSMT
  • DXA
  • Glucose
  • GlycoMark Testing for Glycemic Control
  • HGBA1C
  • Hydration therapy
  • Lipid​​​​​​
  • MNT
  • Non-invasive physiological studies (93922-92931)
  • Routine Foot Care
  • Thyroid
  • Treatment of Males with Low Testosterone
  • Vitamin B12
  • Vitamin D

Access a list of all LCDs. Please note you must know who your LMC is for your area.

 

What are NCDs for Durable Medical Equipment

  • Glucose Monitors
  • Therapeutic Shoes for Diabetics

Access a list of all DME NCDs.