Unlike local FFS Medicare, which often have different Local Coverage Determinations (LCD), all four DME MAC, share identical coverage policies. That is if something is covered in Region A in the Northeast, then it’s also covered in the other three regions. Becoming familiar with the DME MAC LCD in your area where you will more likely be submitting most of your DME claims is the most important knowledge basis of billing of DME claims. The four DME MAC are:
Northeast: Noridian A: https://med.noridianmedicare.com/web/ja
Far West: Noridian D: https://med.noridianmedicare.com/web/jd
Midwest: Cigna B: https://www.cgsmedicare.com/jb/
South: Cigna C: https://www.cgsmedicare.com/jc/
Each DME home page contains a link to the various coverage policies usually under an educational or policy link. One can research both current, proposed, and superseded (archived) LCD. The latter is important to have in case your practice is subject to an audit on dates of service preceding the current LCD. Practices should download any new policy and assign one member of your off staff to stay abreast of any LCD changes. Due to overall policy changes caused by the 21st Century Cures Act, LCD no longer contain ICD10 specifics. However, at the end of the LCD, there are supplementary links to Local Policy Articles (LCA) which contain more specific billing issues. This includes cross waling HCPCS codes with ICD10 coverage. If the issue being covered is extremely complex, a Supplementary Instruction Article (SIA) will also be referenced, which provides further clarification. One should pay attention to the effective dates of any LCD, LCA and SIA. The effective dates are usually noted at the beginning of each of these documents. Any important revisions to the LCD, LCA or SIA are usually noted at the end of the documents.
