tci Part B Insider - 2009 Issue 33

CMS COVERAGE DECISIONS: MACs Can Make Exceptions to LCDs, CMS Says

RACs can only make exceptions to approve claims. Local coverage decisions are known by coders as the "final say" from Medicare -- if the LCD makes a statement, you can count on your MAC to never veer from that rule. But CMS has opened the door to giving MACs some wiggle room in adhering to LCDs. Transmittal 302, issued on Sept. 11, notes that MACs "have the authority to apply an exception to the clinical reasonable and necessary requirements described ina n LCD." The exceptions must be rare, and the MAC can make them only after thoroughly reviewing...

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