National Coverage Determination - Relationship of NCDs and LCDs

Relationship of NCDs and LCDs

NCD decisions are binding on all Medicare contractors, and LCD policy can be no more restrictive than the NCD, although it can be less restrictive. If an NCD or other coverage provision states that an item is “covered for diagnoses/conditions A, B and C”, contractors should not use that as a basis to develop an LCD to cover only “diagnoses/conditions A, B and C”. When an NCD does not exclude coverage for other diagnoses/conditions, contractors should allow individual consideration, unless the LCD supports automatic denial of some or all of those other diagnoses/conditions. When national policy bases coverage on need assessment by the beneficiary’s provider, LCDs should not include prequisites.