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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 provides coverage for items and services for over 43 million beneficiaries. The vast majority of coverage is provided on a local level, and developed by clinicians at the contractors that pay Medicare claims. However, in certain cases, Medicare deems it appropriate to develop a national coverage determination (NCD) for an item or service to be applied on a national basis for all Medicare beneficiaries meeting the criteria for coverage.