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An NCD is mandated at the national level and all FIs, 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 MACâs jurisdiction. Medicare contractors develop LCDs when there is no National Coverage Determination (NCD) or when there is a need to further define an NCD. The guidelines for LCD development are provided in . Chapter 13 of the Medicare Program Integrity Manual.
Medicare Coverage Determination Process. Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). National coverage determinations (NCDs) are made through an evidence-based process, with opportunities for public participation.