What is an LMRP and Where Can I Find Them?

Local Medical Review Policies (LMRPs) were converted to LCDs. This was done as a result of the Benefits Improvement and Protection Act of 2000 (BIPA 2000). The difference between LCDs and previously written LMRPs is that LCDs contain only reasonable and necessary conditions of coverage as allowed under section 1862(a)(1)(A) of the Act. LMRPs may have also contained other information such as coding and payment guidelines. Coding and payment information that is not related to section 1862(a)(1)(A) is not contained in an LCD; contractors communicate such information in related articles.

Local Coverage Determinations (LCDs) are defined in Section 1869(f)(2)(B) of the Social Security Act. This section states: “For purposes of this section, the term ‘local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary- or carrier-wide basis under such parts, in accordance with section 1862(a)(1)(A).”

You can view local and national LCDs through Find-A-Code. You can search all carriers or the carriers specific to your location. Contact a representative at Find-A-Code for more information.


CMS.gov: http://www.cms.gov/Medicare/Coverage/DeterminationProcess/LCDs.html
CMS.gov NCD and LCD Indexes: http://www.cms.gov/medicare-coverage-database/indexes/national-and-local-indexes.aspx

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