Local Coverage Determination Process and Timeline

Local Coverage Determination Process and Timeline | CMS [Skip to main content](#skipNavTarget) ** [](https://www.cms.gov/) Centers for Medicare & Medicaid Services ## [CMS Newsroom](https://www.cms.gov/about-cms/contact/newsroom) ## Search CMS.gov SearchSearch** Popular terms * Physician Fee Schedule** * Local Coverage Determination** * Medically Unlikely Edits** * Telehealth** * Covid-19** * Agents and Brokers** ** ** * [Home](https://www.cms.gov/medicare/coding-billing/guide-medical-technology-companies-other-interested-parties) * [Getting Started](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/getting-started) * [Overview of Medicare](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/getting-started/overview-medicare) * [Overview of CMS Groups](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/getting-started/overview-cms-groups) * [Coding](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coding) * [Overview of Coding and Classification Systems](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coding/overview-coding-classification-systems) * [Considerations](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coding/considerations) * [Coverage](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage) * [Medicare Coverage of Items and Services](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage/medicare-coverage-items-and-services) * [National Coverage Determination Process & Timeline](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage/national-coverage-determination-process-timeline) * [Local Coverage Determination Process and Timeline](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage/local-coverage-determination-process-and-timeline) * [Payment](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment) * [IPPS](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/ipps) * [OPPS](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/opps) * [CDLT](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/cdlt) * [ESRD](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/esrd) * [Physician Fee Schedule](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/physician-fee-schedule) * [Part B Drugs and Biologicals](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/part-b-drugs) * [DMEPOS](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/durable-medical-equipment-prosthetics-orthotics-and-supplies) * [Rulemaking Schedule](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/rulemaking-schedule) # Local Coverage Determination Process & Timeline An LCD, as defined in[§1869(f)(2)(B) of the Act](https://www.ssa.gov/OP_Home/ssact/title18/1869.htm), is a determination by a Medicare Administrative Contractor (MAC) regarding whether or not a particular item or service is covered in a MAC’s jurisdiction in accordance with[Section 1862(a)(1)(A) of the Act.](https://www.ssa.gov/OP_Home/ssact/title18/1862.htm) LCDs can be requested by beneficiaries residing in or receiving care within the MAC’s jurisdiction, health care professionals providing care in MAC’s jurisdiction, or any interested party doing business in the MAC’s jurisdiction. In general, LCD requests are similar to NCD requests in that the benefit category should be specified, evidence should be provided for review, and justification of medical use should be clear. Detailed guidelines for LCDs, how to request an LCD, and how to request changes to an LCD are described in the[Medicare Program Integrity Manual (Chapter 13) (PDF)](https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c13.pdf). Innovators are also encouraged to review any MAC specific requirement or guidelines. ## How to Request a Local Coverage Determination ### Written Request Submission Contractors shall consider new LCD Requests to be a complete, formal request if the following criteria are met. The request must: * be in writing and can be sent to the MAC via e-mail, fax, or written letter; * clearly identify the statutorily-defined Medicare benefit category to which the requestor believes the item or service falls under and provides a rationale justifying the assignment; * identify the language that the requestor wants

LCD requests are made by beneficiaries or healthcare professionals within the MAC's jurisdiction. Requests must clearly identify the Medicare benefit category related to the service or item. A rationale justifying the classification must be provided.

Requests must specify the benefit category and provide evidence for review.

Evidence should support the justification of medical use. Requests must be in writing and sent via e-mail, fax, or written letter.