tci E/M Coding Alert - 2013 Issue 2

Reader Question: LCDs Override NCDs, CMS Says

Question: Our local MAC has a policy stating that only physicians can perform a particular service, but the national coverage decision for that same service says that non-physician practitioners can perform it as well. Do we follow the local coverage decision or the national one? California Subscriber Answer: You should follow the local coverage decision (LCD), CMS reps advised during a Jan. 29, 2012 Open Door Forum. “National policies would represent policy in the absence of a local coverage decision,” the CMS rep said. “If the local contractor sends out a more restrictive policy, that would...

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