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Thread: NCD vs LCD

  1. #1

    Default NCD vs LCD

    AAPC: Back to School
    Can some one explain in idiot terms for me, when to follow a NCD and when to follow a LCD?

  2. #2
    Join Date
    Apr 2007


    It is my understanding that you first go to the LCD for this is your FI aka the one that governs your local medicare. I have yet to come across differences between LCD & NCD in my research of topics that pertain to my field. Hope this helps.

  3. #3
    Join Date
    Apr 2007
    Fort Smith, AR


    That's correct. You would first go to your FI's LCD if there is not one then you use the NCD.

    Darla Sims CPC, CPC-H

  4. #4
    Join Date
    Apr 2007

    Thumbs up

    I have done research as well and have not yet found the difference between NCD and LCDs. All I know is one is National coverage determination and one is local coverage determination. I agree with the previous post. I would code from the local coverage determination if it applies for your state. If not one, then you would use the national coverage determination.
    Catrina Jacobs, RCC, CPC

  5. #5


    Does it matter if you bill part a or b? we bill part b for professional claims and part a for technical.

  6. #6
    Join Date
    Apr 2007
    Columbus, OH


    The same applies for billing both Part A & B. There are just different LCDs & NCDs for the two types of billing.

    Also, if there is an NCD for a particular service, then there shouldn't be an LCD. Local contractors have to follow the national guidelines. (Although some NCDs do tell you the local contractor may have a list of covered diagnosis codes, etc.)
    Amy Crego, CPC, CPC-P
    Treasurer, Columbus AAPC

    One can never consent to creep when one feels an impulse to soar. ~ Helen Keller

  7. #7


    Does NCD trump LCD guidelines or does LCD trump NCD? For example, NCD 220.6 states that they will not cover FDG PET imaging for subsequent anti-tumor treatment strategy for tumor types other than breast, colorectal, esophagus, head and neck (non-CNS/thyroid), lymphoma, melanoma, non-small cell lung, and thyroid, unless the FDG PET is provided under CED. However, our LCD L32663 (New Mexico) states that you can bill with 155.0 Liver, primary but we are receiving denials for this combination.

  8. #8
    Join Date
    Apr 2007
    Columbus Ohio


    Hi Jackie,
    It is my opinion that the LCD trumps the NCD because an LCD can be more restrictive than an NCD, but not less restrictive than an LCD. Anyone else want to weigh in?

  9. #9
    Join Date
    Apr 2007
    san antonio


    I have always been told that if there is a CMS NCD and a regional carrier LCD the NCD should always be applied and followed before the LCD Your local carrier usually says so if asked....


  10. #10

    Angry Ncd vs lcd

    Can someone at aapc whom i paid for a course please answer this? It is on your exam and what we have in our hand out material is conflicting. This question was asked numerous times in different variations on the exam.
    i would not recommend aapc for anyone wanting to take the cpb exam.

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