NCD vs LCA

mhaney

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Can LCA can override an NCD? Our MAC, Noridian, is denying use of an impella (33990) during high risk PCI based on diagnosis; LCA - (A52966). The NCD (A53986) for this procedure show the service is covered for acute heart failure diagnosis. Trying to determine it I can appeal.
 

sls314

True Blue
Local Chapter Officer
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Toledo, OH
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Can LCA can override an NCD? Our MAC, Noridian, is denying use of an impella (33990) during high risk PCI based on diagnosis; LCA - (A52966). The NCD (A53986) for this procedure show the service is covered for acute heart failure diagnosis. Trying to determine it I can appeal.

LCDs only exist when there is no NCD.

A53986 that you referenced is not an NCD - it is an LCD for Palmetto GBA. The link to that LCD number is below - I tried posting a screenshot, but it wouldn't accept the image.

 

mhaney

Contributor
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Yucaipa, CA
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Thank you, I did not catch that. Then I do not find an NCD for this service. Can you tell me the difference between an LCD and an LCA? Both seem to give the requirements for reimbursement. I appreciate the help.
 
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