Wiki LCD Retired

[Partha]

Can anybody explain what is a Retired LCD and what does the following text mean?
"This Local Coverage Determination will no longer be in effect for services performed after March 31, 2010. All local policy rules, requirements, and limitations within this policy will no longer be applied on a prepay basis, but as with any billed service, claims will be subject to postpay review. All Centers for Medicare and Medicaid Services national policy rules, requirements and limitations remain in effect."

Thanks!!!

 

[RebeccaWoodward*]

When a LCD has been moved to the 'retired' list, only those services submitted for dates the policy was active can be denied based on not meeting the LCD requirements. When LCDs are retired, the services are still covered and any related NCDs or coverage listed in the Internet Only Manual will continue to apply. Although a policy may be retired, services must still be 'medically reasonable and necessary.' The medical necessity for services provided must still be documented in the medical record.

 

[Partha]

...so the CPTs will continue to be Covered?

 

[RebeccaWoodward*]

Yes...if medically necessary. I tend to use the retired LCD as a guide if there isn't a another LCD in place of the retired one; but it doesn't mean that other DX's aren't payable if not on the list.

 

[Partha]

Thanks a lot!

 

[dclooney]

What is the rule for Medicare Advantage plans?

 

[KMCFADYEN]

Medicare replacement plans follow the Medicare LCD and some have their own medical policies as well.
Humana tends to follows all LCD's regardless of the region.

 

[dclooney]

Kelly,

Thanks for the information. What is your experience when dealing with a retired LCD?

Thanks!
Danielle