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The useful part is what it refuses to say.

A policy that does not mention a code has not denied it. Most tools report that silence as a denial, because a denial reads as a real answer. Backwork reports the silence.

Silence

“This formulary does not list metformin ER. That is not a denial — the file has no entry either way. Call the plan, or check the tier list at the link below.”

No tier, no restriction, no invented answer. The next step is a phone number, and the reason is stated.

Sourced

“Prior authorization required. The LCD lists eight ICD-10 codes that support medical necessity and names four that do not.”

With the determination ID, the jurisdiction it binds, its effective date, and a link to the page the rule is written on.

Knowing which document wins.

Search returns every policy that mentions a code. That is rarely the answer. Backwork resolves the precedence, and flags a Medicare Advantage plan applying criteria stricter than the determination above it — which it may not do.

  1. NCD

    National Coverage Determination

    Issued by CMS, binding on every Medicare plan in the country. Where one exists, it settles the question and no contractor can contradict it.

  2. LCD

    Local Coverage Determination

    Issued by a MAC for its own jurisdiction, and only where no NCD governs. Two patients in different states can lawfully get different answers.

  3. LCA

    Local Coverage Article

    The CPT and ICD-10 tables that implement an LCD. Coding detail — never the coverage decision itself, though it is the one most often quoted as if it were.

Try it on a code you already know the answer to.

That is the only test worth running on a tool like this, and it needs no account.

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