Local Coverage Determination (LCD)

If you are looking for further explanation and details on Medicare MNT that is specific to your geographic location, then check out whether your local CMS contractor (MAC, carrier or fiscal intermediary) has developed a Local Coverage Determination (LCD).

An LCD is a decision made by CMS contractors whether to cover a particular service on an intermediary-wide or carrier-wide basis (in accordance with Section 1862(a)(1)(A) of the Social Security Act — i.e., a determination as to whether the service is reasonable and necessary). Effective December 7, 2003, CMS's contractors will issue LCDs instead of Local Medical Review Policies. LCDs refer to both:

  1. Reasonable and necessary provisions of an LMRP and,
  2. An LCD that contains only reasonable and necessary language.
Any non-reasonable and necessary language a contractor wishes to communicate to providers must be done through an article.

To see if your local contractor has an MNT Local Coverage Determination, go to the CMS Web site to search for coverage determinations. Select "Local Coverage Documents," then type "medical nutrition therapy", then select the state desired in the "geographic area" box.