Wiki Medicare new LCD/NCD advice

Sarahlukkarila

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Hi all,

Has anyone had experience trying to get a new LCD or NCD with Noridian? If so, do you have any input, comments, or advice on this process? We have been trying to get coverage and the whole thing has been a headache.
 
Sometimes there is not an LCD or NCD for specific things. Do you have the LCD/NCD number that you are looking for and i could maybe help you.

Thanks
Misty
 
If a payer requires and LCD in the primary position and we have a diagnosis. Does the LCD have preference over all other diagnosis's even if it is not the primary reason for the service? Also is it allowed to be placed in the primary position? Thank you
 
Hi all,

Has anyone had experience trying to get a new LCD or NCD with Noridian? If so, do you have any input, comments, or advice on this process? We have been trying to get coverage and the whole thing has been a headache.

It's a process, and it may be determined that a policy isn't warranted for whatever reason.
 
Have you gone through this recently? Or have had any luck? Our PLA code is not on the fee schedule and doesn't have a coverage policy. So trying to connect with people that may have had luck with this process. Our PLA code is breast cancer related for prognostic testing and MACs told us we had coverage with out an LCD/NCD then went back on their word and have been denying every single claim we have submitted. Regardless of documentation submitted!
 
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Hello, if you are denied on LCD, I would speak with the payor and request what policy LCD number your claim was denied under since your PLA code is unlisted, go from there. If it was denied for medical necessity denial CO-50, then you have to go through the payor appeal process.
 
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