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The
LCD Knowledgebase is a national database of Local Coverage
Determinations (LCDs) to help address overall
compliance, ensure legitimate reimbursement and avoid claims
being denied for lack of medical necessity.
Passport distributes the electronic databases of LCDs in
addition to the National Coverage Determinations for Clinical
Diagnostic Laboratory Services (Lab NCDs) and,
optionally, the Correct Coding Initiative (CCI) edit checks
which CMS regional Medicare carriers and fiscal intermediaries (FI)
use to determine the medical necessity and compliance of
Medicare outpatient claims. LCD and Lab NCD updates are provided
electronically within 30 days of posting by the contractor.
Six categories of information are maintained within this
database as part of each LCD:
- Covered
Diagnosis
- List of specific ICD-9-CM codes that the Medicare carrier or
FI accepts as evidence supporting medical necessity
-
Non-Covered Diagnosis
-
List of specific ICD-9-CM codes that the carrier or FI
identifies as categorically not covered (Statutorily Denied)
- Codes
that Do Not Support Medical Necessity
-
List of specific ICD-9-CM codes that the Medicare carrier or
FI does not accept as evidence supporting medical necessity
- Narrative
Conditions
-
List of narrative terms or conditions that certain carriers
or FIs will accept as evidence of medical necessity in place
of an ICD-9-CM
- Messages
-
Comprehensive
information for the service providers directly from the LCD
which includes the indications and limitations of coverage,
documentation guidelines and reasons for denial.
- Questions
-
Specific
criteria and frequency indicators associated with procedures
are represented as Questions. Responses to these, in conjunction
with typical medical necessity evaluation, determines
whether carriers or FIs will reimburse the provider for the
requested procedure.
Download
LCD/NCD and commercial edits databases PDF
You might also
be interested in our medical necessity compliance solution.
View online
medical necessity compliance demonstration.
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